Skip to main content

Full text of "A Handbook of Therapeutics"

See other formats


Go ogle 



This is a digitaJ copy of a book that was preserved for generatioDS on library shelves before it was carefully scanned by Google as part of a project 
to make the world's books discoverable online. 

ll has survived long enough for the copyright to expire and the book to enler Ihe public domain. A public domain book is one that was never subject 
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vmy country to country. Public domain books 
are our gateways lo the past, representing a wealth of history, culture and knowledge that's often difficult to discover. 

Marks, notations and other niaiginalia present in the original volume will appeal' in this file - a reminder of this book's long journey from Ihe 
publisher to a library and finally lo you. 

Usage guidelines 

Google is proud to partner with librai'ies to digitize public domain materials and make them widely accessible. Public domain books belong to the 
public and we Lue merely Iheir custodians. Nevertheless, this work is expensive, so in order lo keep providing this resource, we have takeD steps to 
prevent abuse by commercial parties, including placing technical restrictions on automated querying. 

We also ask that you: 

+ Make non-commercial use of the files We designed Google Book Search for use by individuals, and we request that you use these files for 
personal, non-commercial purposes. 

+ Refrain fivm aiftomated querying Do not send automated queries of any sort to Google's system; If you are conducting research on machine 
translation, optical character recognition or other areas where access to a laige amount of text is helpful, please contact us. We encourage Ihe 
use of public domain materials for these purposes and maybe able to help. 

+ Maintain attribution The Google "watermaik" you see on each file is essential for informing people about ihis project and helping them find 
additional materials through Google Book Search. Please do nol remove it. 

+ Keep it legal Whatever your use, remember that you are responsible for ensuring thai what you are doing is legal. Do not assume Ihat just 
because we believe a book is in the public domain for users in the United States. Ihat the work is also in the public domain for users in other 
countries. Whelher a book is still in copyright varies from counlry lo counlry. and we can'I offer guidance on whelher any specific use of 
any specific book is allowed. Please do not assume Ihat a book's appearance in Google Book Search means it can be used in any manner 
anywhere in the world. Copyright infringement liability can be quite severe. 

About Google Book Search 

Google's mission is to organize Ihe world's informalion and lo make it universally accessible and useful. Google Book Search helps readers 
discover Ihe world's books while helping authors and publishers reach new audiences. You can search tlirough the full text of Ihis book on the web 



at http: //books . google .com/ 




6000305131 



A HANDBOOK 



OT 



THERAPEUTICS 



BT TEX 8AJCB AUTHOX. 

Second Edition^ flztull Sto, &. lU. 

OH THE TEMPERATURK UI' TUK BODY AH 

A II>1AKH OF UlAGNOHIB AND 

FEOaKOmB IN PBTHtSia 



IxnuoK: B. K. LBWltt, 13«, Oowu Gmn. 



A HANDBOOK 



OF 



THEEAPEUTICS 



SYDNEY RINGEB, M.D. 

rKomeoh or thi pbiucitleb amd rBAcncE or uxmciHi in unviBsiTT collioe, 

rBTHICUV TO DHrvnuiTY COLLEOK RoaFtTAL 



TENTH EDITION 



LONDON 

H. K. LEWIS, 136, GOWER STREET, W.C. 

1863 



it^^.e^.i^ 



u 



PREFACE TO THE TENTH EDITION. 



Iir preparing a new edition of the Handbook of Therapeutics, 
especially intended for stadetita and yunng practitioners, I have 
endeavonred to make it as practical eu posaible. 

The method I have adopted in this work is tb follow oat in a 
certain order, in detail, the physiological and therapeutic action of 
individoal drags on the body. For the most part I have treated of 
the action of a dmg, first on the skin, nest on the moatb, then the 
stomacti, the intestines, the hlood, the nervons system, tho lungs, 
the heart, and finally on the excreting organs, dwelling most of 
course on the organ, or organs, mainly affected by tho dmg under 
consideration. 

In this edition I have endeavoured to put the reader in possession 
of the latest facts, and to give an account of various new and im- 
portant discoveries made since the publication of previons editions. 

The elaborate analytical indes, prepared by the kind labour of my 
friend Dr. Theodore Maxwkll, will be found a time-saving and 
valuable addition to my Handbook. 

I am anxious to express my great obligation to my friend Dr. 
Geosge Bird, who has assisted in revising this and several previous 
editions of the Handbook, and who has increased its usefnlnees by 
many suggestions. 

Augtut, IS83. 



CONTENTS. 



?AOE 

Introduction 1 

On the Tongue . 2 

The Pdlse 6 

The Skin 19 

The Temperature of Health 22 

Temfbeatlre of Disease 22 

Abkobhai, Elevation op Temperature, oh Fbvbe ... 23 

Chronic Fever 30 

On Dkopst .41 

The Effects op Cold ok the Bodt 45 

The Cold Bath, ikcluding Sea-Bathixg 47 

On Packiko with the Wet Sheet 55 

The Influence qf Cold Bates in Fevers .... 58 

The Warm Bath axd the Hot Bath 64 

Shower, Douche, and Sfosqe Baths 67 

The Turkish Bath 74 

Poultices and Fomentations 79 

The Medicinal Uses of Ice . 86 

On the Spinal Ice-dao and the Spinal Hot- Water Bao . 88 

The Spinal Hot-Watbe Bao 90 

The Internal Use of Water 91 

On Fneuata 94 

On Acupuncture 98 

" coc.nter-irritation " or the influence of external aoents 

OH Disease 103 



Ottoen 125 

Peroxide of Htdroqen 126 

Carbon, Animal Charcoal, Wood Charcoal .... 126 

Carbonic Acid- 129 



Till ^^^^p C»STESI8. ^^^^^^^ 

SEru-Rri ISO 

Thi SCLrniin of Potarsicx, Somdu, AuMOKiirii, ixB Caloidh. ISi 
Cmlohiici OjtM, Ciii/iiiiN'c Watbk, CnLouiXiKD Sou, Cnuv 

RiVATxp LtHi:, AW TfiKin SoLvrioxs 141 

TODWI! 143 

. A nivr I.vrHflDttCTOiiv RcHiBKH RcuiRcneo ran BKUTrvs Kmon 

or PoTAi^KICU AM) SouiLH Saltb 148 

lOblM or P0TA8StU)l, lODIM . OF SoDrw, AKO lODIPS OF Am> 

MOSIVM 15L, 

BBOMtDE or PcrrASSirw, Somen, AMWOsiitu, akh Lmiii-ii . . 1^ 

X ThBOST COJiCKKJCIXO TBB " ToPICAl. " AcilOS or AOIDS AXO 

AlKALni9 ON Skcki^'iok 171 

Scu'BtRic, HvnKocnLOiiic, Nitric, Pbosfhoric, akd Acetic Aciii 173 

^Si;u-iinKiD» Acit>, Sl'u-iiiics, HTFOBCLTHiTea . . . . IHZ 

Cnnoicic Acii> 18C 

Qnnvv HHBRAaxo CAVumc Pota«u, Solvtiox or Potahii, Cak- 

IIOXATR kSt) BlCAIIilOKATS Of POTAKII, ActTATf ȴ POTAKH, 
ClTRATK or PuTASR, ASD Tillt O0i>llK!ll-OXI>lXU pKCrAUATIOKS 

or Soda, Potash Soap, Soda Soap, IIokax . .It 

SOLLTIOX or AmAIOSU, CaRBOKATK of AXHOiCtA, SrtRITS OP Alt' 

Mosu 202 

AOmsiA, Liairr Maoxrbia, CARttoxAii: or Maokesia, Iiioht 
CARWiiArR or UAOSEiiu, Solution of Cabiionaik or Uau- 

XKMU 2U6 

lanK. CAurno Tjur, Lmr^WATKii. Likivkxt «r riiHH, Saccua- 

KATKO SOLL'TtOa OF LiMR, CaRUOXATS OF liitIK . 

PuoeniATit or LtiiK 21^ 

UTK»-Botti-uiTE or LiuE, UvKinioapHnB or Soua . . HG 

Cui'OKIliS (IF POTAHHIl'li, ClIlxiSIDR Or SOOIOM, CuUiRltlt OT 

AuHOKicM . . . . im 

QUOVV COVTAIXINO SOi-fllATK i>|- PoTASII, SuLTIIAn OF SotIA, 

SuLrnATK or Mahmmia. PiiuKi-iiAric or Soda, TAsruAn of 
PtrrAMii, DrTABrnu'ni or Potahii, TARTUAric or I'oiahu aud 
8oM )tl8 

MmuTi or PoTAiM. Niibatb of Soda SS& 

CnuKATii or Potash 

'AufH, DttM Aluu, AcKTATi or Aluhiha 2301 

PlRFARATIOXH OF IltOX 234 

BAtn or MAKiiAMsaR S-11 

NtTtATi iir IlKituni, Caiwxati or BiturTii . 



Lbid Salts 245 

ITiTRATE OP 81LTEB, Oxide of Silver 252 

Mebcdkt ahi> its Prefaratioss 257 

pREPiEATIOsa OF COPPEK 276 

PBEPABAT10X3 OF ZlHC 278 

Peeparatioss OF Antimost 281 

Pbbfabations of Arsenic 288 

Phosfhorcs 314 

Collodion 319 

Cod-Liver Oil, Aluokd Oil, Poppy Oil, Hbhp-Seed Oil, 
LixsGED Oil, Cocoa-Nct Oil, Ddoong Oil, Palm Oil, Lard, 

SCET, Wax, etc 320 

Castor Oil, Croton Oil 330 

Gltcerixe 333 

On Diffekest Kinds op Tannin, on Gallic Acid . 334 

Hamajielis Vibginica 339 

Tar, Cbeasote, Carbolic Acid, Petbolecm, Oil of Tab, etc. . 340 

Mirss, Castokecm 348 

Alcohol 348 

Chloroform 368 

Ether 309 

NiTHOOS OiiDE Gas 372 

lODOFORU 379 

Htdrate of Chlobal 380 

Hydrate of Croton-Chlobal S8lj 

Nitratk of Ahyl 391 

Nitro-Gltcebine 3S>i» 

Camphor 402 

Tlbpe.ntine 405 

GrOL-P CONTAINING: — NuTJIEGS, ClOTBB, CaNELLA BaBK, CiN- 

SAMON Babe, Cajeput Oil, Oil of Anise, Fennel Fruit, 
Caraway Fblit, Coriander Fruit, Dill Fbuit, Elder 
Flowers, Lavender Oil, Oil of Rosemary, Oil of Sandal 
Wood, Oilof Peppermist, Oil of Spearmint, Oil oe Roe, 
Oil of Lemons, Cubebs, Buchd Leates, Balsam of Tolu, 
Balsaii of Pebd, Copaiba, Mezebeon, Sassafras, Storas, 

Juniper, Benzoin, etc 408 

eucalyptis 412 

Valerian, Valerianate of Zinc, Valerianate of Quinia, 

Valerianate op Ammonia 412 



not 

SATtKE 413 

AsSAr<EnsA, AHHOXUCnH, Gubakuh 413 

Cakthabidbs 414 

Mustard 417 

Capsicum 419 

ipbcacnavha and its pbeparatioks 421 

YiRATBUH ViBi&B, Yebatbuh Album, Ybbaibu (Sabadilla) . 434 

CoLCHicuu 438 

fodophtlluh 441 

Stafhisaobia 446 

Acixi Racihosa 447 

ACOKITE A»D ITS pREPARATIONB 44it 

Digitalis asd na Pbeparationb 401 

Tobacco 484 

comuu and its pbefabatioxs 480 

Galadab Bean 4!>3 

muscabik 500 

Jabokandi (Pilocarpisb) 505 

Geli)bhiui( Sehfebvibeks 5011 

Orindelia Bobusta 519 

Therapeutics of Belladonna 5:il 

Ethyl-Atbopium, Methyl-Atbopiuk 545 

Htosctamub 540 

Stsauoniuu 550 

DoBoisiA MyopoROiDEs 550 

Htdroctahic Acid. Cvakide of Potassiuh .... 551 

Opium amd itb Pbepabations 55:i 

TSvx VomcA, Stbtcbma, Bbccia, Thibau .... 560 

Lobelia Inflata 578 

Cakkabis Ikdica 58iJ 

Begot 5H2 

Tea, CoiTEE, Cocoa, Guarasa 585 

clnchoita akd its alkaloids 587 

Saliclve, Saliotlic Acid, Salicylates 51)7 

Quassia 013 

CUAMOmLB 613 

Elatebiuk 614 

CoLocnrtB 614 

Aloes 615 

Sqdill 618 



it 

CONISflTB. xi 

rua 

JaUP, SoiHHOKT 616 

Bhobabb .... 620 

Sesna 621 

Skkeoa ' 621 

ANTHELHnmcs 621 

DiETtRT n)B Iktalids 627 

I<4DEI TO ThBEAPEUTIC AflENTS 643 

Ili'DXX TO DlSBASBS 647 



THEEAPEUTICS. 



ISTEODUCTION. 

I HATB Uionght it mif;lkt prove nsefnl to tiio stnddnt &nd Ut the 
jroung pmctitioncr to insert in tlii« i-ditiou iv brief acirannt of tlio 
nyrajAoma of disease. Of lat« years, eiace itttention hoa been mora 
drawn to thii ei^ifiCAnco of physical Ktgns, too littlo hocids to rw to 
bo palil to the detoatton and uppieLJation of sjiuptoma, objective and 
snbjocti^'c. This h & mftrkyii defect nmniig students. Ono often 
iucgU with a (itndcat, thori>ui>hly equipped with all tlie rtuouruen 
portBiniog to pbynical diapnoMN, who yet in (orely paxxlod with the 
indications afforded by the pnlBO or tongne. The reason is obviuus. 
Phyniuol Kigna arc tova l«&mcd, whiUt it rcqniniii ii hnigor timt:, more 
(wtience, oud a more discriminating obsorvation to appreciate tho 
meaning and to cutimnto the value of nyinptoniB, 

The iudic»lions of diw/iso arc divided into symptoms and " phy- 
eicnl nignM." The direct infonimtion to be obtained from tho polsCt 
the skin, the ton^e, the broutliing, the oracnations. ilc, are, for 
ronTOnJOnoc, termed ohjectiro syrajitoma. The indirect information 
we gather from the patient's description of his own feeling and 
^•nnlionit, which are lictected only by the jiatient himitctf ; tbgM^ 
likewise for the purpose of convenience, are termed subjeotiva 
xymptomx. Important IhoD^h phyncftl inga* nndonbtudly are, yot 
symptoms, especially objective symptoms, are far more valuable. 
Phyiii<»] aigns, a* n rule, help its to detoct only cottno and 
decided obongee, and ore chiefly nsofn] in diagnosis, whilst symptoms 
•re hr mon Djwfnl guidiia in proKtiosia and in treatment. 

It RMiy be said, ibat befora wo can ofEciently treat a patient, we 
most lirirt form a eorniet diagnoBis ; hence phynical Figns, by greatly 
asfiisting na in this reepeel, mnst likewise greatly aid in the treat. 
mont. Id Mine meainre, this propoution is no doubt Imo ; but when 
wfl bare •ociiiat«ly diagnosed the disease, we treat> in most cnsea, 
tlie MoondMy tBeclx rather than the primary disease; and these 
Moondary vEFccts gco«mlly make tlivuisvlves apparent solely ta 

B 



tjmptomi. Only in ft few instancos, iw ngnv and K^liilis, can wo 
dtrootljrcnrcthedutcuw iudf; but in oUier inalAnciw wo miiKt bo oon- 
t«at to combat tiie eeoondarjr and often fdtsl oSeots. A. disMse oft«n 
noithcr «ndftnf(7n> nor destroys life by its direct effect on ,tho orgui 
attacked, bat through a socondkry cfFccI mnnifeKtod ou aQolher organ 
or orgfuis. Thus to take tbo euo of pneiiiuoma ; liore, by no mtwis 
onfreqaently, the dangers depend, not on the condition of Ihe lung, 
bnt on Dorvons or canltao deproMion. The fvver depreewa iho 
nervous system, shown in slncplcnniOM and dutirinm, and tliis depressed 
MHloof tho nervonx system cMueacardtacweakoees and so endangers 
and destroys life ; or tbri fcTcr muy directly drprum the heart and so 
iroakan it that tbu putient dies> Now in both these inslanoos, the 
flSectfl on tbo nervons system and on the beart< are manifestod solely 
by symptoms, and withont dnc a{>|n«eiation of, and proper attention 
to thceo symptoms, to much tho wor«« for the patient. 

laalaucM like this mif;hl be multiplied to Biiy extent. Moreoror, 
Hum 18 the wide mnge of diseases in which physical diagnosis is on- 
RTailuig when there are only symjttoma to piide our tnatmenl ; and 
anlcM tiauiod to tho reoognitioo and eslinuition of symptomB, tbesa 
M« jnst the easea in which tho young pravtitiuner ia more likely to 
find himjHrlf nt sea. 



OX THK TONGUK. 



i 



Wi escamino the tongne to osoortaiD whether it is clean or furred : 
di7 or motsl ; it* oolonr, Jkc, 

What is the BManinii; of a furred ton^s ? 

A loofcne may bo furred from febrile deecase ; from local cansoa ; 
or from sympnthy with the stomach, intestines, or liver. 

The condiliim of Ibn finpoe in fever U, pofhaps, moru a help in 
jiTQgDOsia than in troalnteiil. la muHt fevers tlio tongue at first is 
cOTered with a moist fur ; but in some cMOa tbo tonguK. stmntro to 
say, remains quite clean. Sometimes this is (ho cnco in tr]>hi>id 
fever. Now tlie coated tnn^ne in ferer does not give us mnch sbiT' 
gestion witli n-ipinl tn treatment, for whether the lonnnn is clean or 
fool, if there is oonstlpation the bowels most Ira roliered ; and if the 
tonguo la <rery foul, thut is, thickly coaled, a moronrial purge isbmt, 
tbovgh whilst Uin fovrr cnnlinoes some fur nsnally remains. 

Loral cansue oftt'n fonl I'le tonKoe. KnlarKrd toBsib often emit 
Ihe back of tlie tongue Deoayint teeth ufl«n fur a pai;tion of tbo 
ton^c. If one towul only is vnlarsinl, or if llio ducayml treth am 
lutaatad on ooo side, then only one tonjptudinal portion of the tongue 



7BB TOSQDIf. 



ft 



h ftirred. In noornlgia of th« fifth, wfaon tho loirer brfinclios aro 
sS<<ct€<I, tbo tongno on tba nonralgie sids in apt to beoomo furred. 
I BxoBlrive Bmolno^ ftlmost bIwajb fnra tho tongao. 

The tongao votj frequently ii)dicat«!i derant^moat of the Btonuob, 
bowolB, or lirer. For instAncc, if tliorv ig no forrr, and no local 
came, as enlarged tonnila, bad t4)etb. Ac, tben a coated tongno in- 
dicntc* nine disturbance of tbo prinuo vim. 

What docs a coated traigue nnder tlicse ciroumictiLnocii indicnte f 

e shall mrelj go wrong in taking thin fnrrod tongno as an indica- 
tion for ono of foar modicinr!), or aomo of tliom oomliintrd : nontolj*, 
meroni^', podopbyllin, tinctaro of nns vomica, or nitric acid. 

How arc w<! to dotxirminc ivhi<th to give and iU doHii ? If tbor« is 
constipation then give a mercurial preparation or reain of podopbyliin 
IB purgBtirs doN*. Any piirgntivv, it ia tnin, will liorv be tisofnl, 
CBpMianr tbe natontl pnrj^ative watera, aa Fnllna, Priedriohaball, 
or Carlsbad ; bnt tboeo, tbongli valnabli; rrmodics, arc in manj in- 
atKiicea inferior, in Ibe cases in qnostion, to meionrial and podo- 
pbyllin pnrgn. 

Am KfpixAt merotuyi onr choice falls either on calomel or blue pill 
for ndnlte, orcalomol or groj- powdor for ohildron. Tho calomel or 
blue pill should bo combined with extract of tx^lladonna or of 
hfoacjramns, SLUM thia addition obrtatcia tlio griping and cortninly 
teems to enhance the action of Uieeo drugs. An etfooiiTe doao in 
half a irmin of calomel with throe gmina of extract of Iijoeojramng, 
for throe oonsecntive nights ; tho firat pill generally purges pretty 
frvoly, the aocond ntncb luut freely, and the third sc&rocly at nil, 
thoogh it helps to clean the tongue 

Which should we chooee— meronrial parges or podnpbyllin resin ? 
The answer to this qnostion d«pond« on tbo colour of the stool. If 
the motions are too light-coloured mercarial purgea arc lx«l. If, 
OB tho other band, tho motions are too dark tben podophvlliii ia 
aeoded. For thia clinical fact I can gire no explanation. 

^Vhat is to he done when the bowels are freely open, or haro been 
by medicinev Imt whero the tonguir iitill continues fnrred ? 

e meet with aucb caaea often in gastric, biliary, or intestinal dts- 
tnrbauice, and xometimca in the early convalcitccnco from acute illiieas 
the tongne does not cloaii so quickly aa it should — a sure eJji'D of im- 
[uirod digeetion. Here again a mercurial preparation or podopliyllin 
i> nsefnl, giren with tincture of nnx vomica and nilrio acid. If the 
motions are too light then give a third or half a grain of grey 
powder, night and morning or throe times a day ; if the motions aru 
tint dark then givo a mnoll dote, say a thirtieth to twentieth of a 
grain of podophyltin r«eiD, night and morning. Five drops each of 
liiDctnre of nnx vomica and dilute nitric acid thrice daily, will ninob 
I B 2 



^Vha 
^»la»)d 
^WTene 



fBI TOKOUE. 



l>raiiio(« tlie ftdton of (he m»Teoij and llio podoplijltin. Somotin 
thefnr is dirt^nr brown, tmd the patient complaiua of a diaagreeable 
Intter tttsl«, «epeoial!y in tlio muruing, and tliU nympUtm in nn 
additional indicatioa for the foregoing txeatmeDt. SometimeB, bow- 
tter, in spit« of Uiia tn*lm«Dt, tli« diangrveable bitter taxio ptmials 
in the raoniing, or even during thogrcAtor part of tiu> day. Riiuiog 
Uia mouth with a nolutiou of ]i«riiuuigaiuit*> of potneb will gonondljr 
temporarilj remove the annoyaoiw. 

Aa tlio t«wgao cloanit the far locudwi from the tip and edgM and 
gmduallj beoonies thinner, eapeciallj at it£ margin. With a little 
pnctjce wo can generally deicct when th« cleaning process is going 
on. 

Aftor an acnUt illnms like typhoid fever, the tongoe BOUetimes 
parts with its fnr in flakua, leaving oImu* Hniootli jiatches, rspccially 
at ita back. Tbia tongtio d«DDt«sa alow conmlosceuco. lu typhoid 
ferer this tongne may a second time become dty, vrith.n ivtarn of tbo 
abdominal symptoms. In a case liVo tliis tnrpontiue is indicated ia 
10. to 20-minim <lo«ies every two or ihreo bonn. 

A dry tongue occurs most frequently in fevor. The dryness firtt 
inTadcs tbe tip Bud o:xt«nds up tbecuutfo, sprai ding the nwaitwhilo 
latondly, till the whole toDgne becomes dry. Itgruwrs moUt in the 
iuveriM) order of ita inrasion. A dry tongue gentrrally indicates 
nvrrons d«prMaion, oftan shown by deliriam, usually of » low 
muttering kind. This non-ona prostraliou is oftvn dopeadmit OB 
wantof 8l«op. XarcotioB tburvforc like chlonti, bromide of potaarinm. 
or opium, by indueing sleep, sootlw niid strengthen the nonroas 
system, and indircctJy notatea the tongue. Opinm is often more 
nauful than bromide of iMtasstanii or chloral, for opiom appears (o 
have a greator effect on tlio toogne than either of the other dmgs, 
pnihiibly inducing a nioisi condition by its dirv«t action cm tbo 
tongne and stomach a* well as Ibrongb ita sleep- producing effect on 
tbe Dervons sjrKtvm. 

Being frequently a sign of nervous depression, tbo dry tongue Iw- 
ooraoa also an indioation for giving aloobolic Httmnlaats. If, liow. 
crrer, tbe nerrooa dapreasion is due to wakefulness it is better, if 
possible, to secure rvfresbing sleep by k >ua|>nrili(', which, by Mo«ithiug 
and strengthening the aurvoas syKtora, rcndcra the tongue moist, 
promotes digvstion and nsdmilation, and incites the patient to take 
more food. 

Tbe two chief uses of atoobol are to asiiist digestion and to Mistain 
tliv iiurvonn system. Now sleep is the l>c«l restomliTL' ; heiice fever 
patiunt* who sleep well du not as a ruUt rvquire stimulants. 

If kleep oaanot bo seouivd, or if in spile of alei>]> tlie tongue re- 
mains dry and the delirium jieniats, then aloobol is indicated) thoagh 



I 



( 



THB TOSacl. 



» 



tlie pnlso 18 a bettor goide. Usunlly, Iiowever, a patient with « dry 
tODgno IiM K frequent, quick und comprcesiblo pnlso cnlling for 
alcoholic stimulation. 

Whilst the tongue often iiffordK o^-idG1lco of th9 necessi^ for 
alcohol, eomotimn it showa wbm it do« barm, for if the tongne 
^owi coated or drior, it ta flrident that the stimulant is doing 
miBchief. 

The tongnv in an agod ponton oftvn roadtlj becDin«e dry ovoa in 
non-febrile illnesses;' h«nce a dry ton^e has not quite tho same 
wrioiis import «« n dry tongno in a younger parson. If with tho 
dry tonf^no there is sleeplessness we must be careful how to it'ivo 
•oporifien ; for though in many cases a sopoHlic is very beneficial, 
yet in old people sometimes it produces great excitement. If the dry 
tongue is ».i»ocintcd with deprusKion or cxhanslion wo not at all 
rarely find that alcohol increases the dryuesa ami deHtroys the 
appotit« ; banco, at tiret, stimuliinttt must bv given to agod patienta 
in ft omoU qnanti^, tho effect of which must l>t> carefully watched. 

In typhoid fover, a dry, aroootb, and glazed tongue, or simply a 
dry tongue, indicstea the employment of oil of tnrpentino; Ic-u to 
fifteen drops in mncllagc, cvpry two hours. 

The colour of the tongue is a oseful aign. Abroad, pak-, (lahhy 
t«eth-iodnnt«d tongue, iudicatea aniemi* with a relaxed condition of 
the tisanes. It is met with in simple antemia, and cliloroiiis, and in 
some chronic disoaw*. a* in Bright's disease, in which, in aildition 
to auiemia, there is hydramiia — an eiccsa of water in the hluod. 
This toDguo always signifios the need for iron ; and the astringent 
preparations in lari;;e dosea are, as a role, far the best. A nwolleii 
forth -indented tongua during a coanio of mercury, ia ono of tho 
oirlicat signs of salivadoiL 

In diab«tCN, in ututo and advanced caaca, the tongue is often 
(Hunwleristic. It becomoa smooth, ghized, shiny, beefy -looking, 
afaoormally clean, often witli a tendency to become dry, and Komo 
timea qiut« dry. 

The tongno may be red, with prominent red papilla) most marked 
at the tip; and this red tongno too clean, too smooth, or slightly 
furred pointa to " the irritable tongue " and a corresponding state of 
tlte KtofDaeb. It is met with in certain dyspeptic cases somotiraos 
in ilrunkurd)!. and etpectally iu phthius when the iutestinc!! are 
uleemled or ihora is tuborcnlar peritonitis. Small doses of arsenic. 
Bay ono minim of the liquor, given shortly before fuod, will goner* 
ally Improve this tongue and the associated conditions. It should be 
borne in mind that great irritation of tho stomach or intestine* or 
tnbenalar peritonitis may exist, unaccompanied witli this irritable 
tongue. 



b THI Frus. 

la acariet Urrer, » few tUys afl«r its conmewMawBt aad batoNtlw 
fpTor ducliiMM, Uiis toagno is met with, and it eontiniMfl dorinf' tlia 
earl; part of cODTakeceDCft It is tfae vtaj characteristio " itntw- 
htirrj tongDe," alwafi raggMtiva of tcarlot tcwr. ltd npi>e«nDce 
ariSM frma deiquaiaation of the tOBgne, for ihv cuticle of tha 
tOBgoa beta^ moist is moro oasiljr Mpanit«d tban tho cnticlu of the 
BloBt benoe tlve toajfue i]«quanut«« Bone days before tliu akia. I 
aeod hardly gaj, that nliilst the fovor laats, we should not tnat Ibe 
Umgat wilb arsenic, tkoo^h, if coaTalesoeaoe is t«dioaa aad the 
tonKne rvtains its Btrawbvrrjr cbarador, ancnic and sitrio add wiU 
be fonnd aMtfnl. 

Tha " iwrTons tonguo "* is also very aoteirotilij' : gvneraUy (t is 
■nry alightty coatm) aod oorcnd with a alight froth, most atarkod 
oloaa to the edge. Wo ouwt with it in poraoas of nervona tempom* 
BMat, eepecially duriag the period of excitvraenl, and is cases whit* 
tbo nctrons system has be«a depreased by OTcrworlc, and worry. 



THE PDLSE. 

WtTB each contnction of the boarl, n wavo ii Mcnt ifaraagh tho 
arterial liyelcia, which, in its joothot along the wsbels. diatendt 
then) ; aad this periodical distensioii. readily felt wbea the Bagera 
nru ]>lac«il on an arteiy, b the palae. Dr. Broadbeut, boireveri 
doBJM that the imbs is <Iaa to disteasioD of the artery, and asoribi* 
it to thu vrave forcing or trying lo fores the reneJ dattetud by 
prvmura of the fiagvr back to its cylindrical form. I'hs pnbe, 
Ihernfon;, dvfiends on tholuMirt; and varies with the oonditioa of 
the bunrl. It is iaflucnoed also by the comlition of tlie vessels, tlia 
palaa vaiyiaK aocordini; to tbn conttaotod or dilated condition of the 
arteries ; laonover, it is also UMidiBed when the walls of the rossels 
tmoUM flbnms or calcarvous. Tlui pulse is an ncmimle indrx of the 
conditiaii of the heart, and is thurefon) tho most nlnsble gnide in 

dlMMO. 

Ilui Importaaoo of the imtae ia nwnifeat when we oonsider thai 
disease kills by arrostisg the hoart. Wliibi the heart boats there ia 
life anil hope. In nMoy inslancea, thu pubu given the proin|>l«st 
signs of dangvr ami the rarlicsl indioalions for tftMtmcaiL To tUus* 
tralo this by an axample, take tbo ease of punuaonia, in which dis* 
BBsa sn long as tlio |nUso cotitiaocH good wi> liavn (sir hopes of oar 
patient. In some patients tho heart fails early and tbo palso aoofl 



THK eOlBX. 



I 
I 



revwla tbia condition ; the patient fails, we ny, nt the boftrl. la 
other iDBtanoes, the nerrunit sj^stpm lint gives wivj, ebown by sleep* 
lesaiwn vtd maWsiiag deliriam; hot though thciiu K^naptoms iwaso 
aaxietf , yet so long u th« pulse remains good, vre hope to save our 
patient. Tfao anxiety we foel with re^nl to this ncrvonit pvrttirhittioii 
UiBM from its depreniiig effect on the heart ; for if the patient does 
not sleep, tlus nmyist, with the consequent dolirium, rapidly dnprCMcs 
and weakens the patieut, and at last arrests the heart. The disease, 
therefore, nay diieotty tell on Oie heart, or it mnj indirvclly nHoct 
thifl organ by ita depressing eSoct on another system. In any case it 
ia the ultimate effect of the diteaso on the heart that dcstioyti Ufa. 
It ia hardly possible, thein^forc, to oror-estimato the cardinal impor> 
tanct! of ihie pulae. 

The pulso-beats may bo frequent or infrequent ; alow or quick ; 
amall or large ; compressible or inoompFDSsiblu; regular or imgnlar ; 
or intermittcnl. 

By the frequcuey of the pulse wo mean the nnmbcr of beats in a 
given time. 

In a quick pnlse each beat cccnpies leas than the usoal t^inc, that 
ia. each ware is of short duration relatit-oly to tho pause between tho 
wares. 

When the Tolume of tho pulse is greater than usual, it is said to 
bo large; or the rolnmo may bo loss than nsnal wbvn it la said to 
be email. 

Whan the lingers can easily stop the pntsu it is said to be com- 
pressible ; when, ou the other band, it can be arrested only with 
diflicnlty or not nt all, tho pulsu is said to bo inoompreisibl^ 

The pulae may be irre^ar or iDtermittent. In an irregular pulso, 
CttOBOoding boats differ in length, forcv, and obarncter. In an inter- 
mittent pulse a beat is from timo to time losU 

'riio freqaoDcy of the huollliy puhiu varies ; thus in some penons 
the normal pulse is 100, in others aa low as SO a minnte, but theso 
extrsmea are nre. 

Five cmditions produce a frequent polae i Feror, debility, cxcito- 
ment, hysteria, and cardiac disoa4w, na in some oases of mitral duiuftMe ; 
and the poise in Mophtholmia goitre ia greatly accelerated. We 
BoldoBi experienco diOiculty in d<.-tonmning the cnuM of the nocol. 
orated pnlM. In excitement the ai-ueleration is not persistent and 
lasts only wtiilst tho excitement eontinaos. Hysteria may greatly 
and permanently acoelenito the pnbe to even l^O or 160 beats per 
minnto. Bnt in a gtave illness, whether fobrilu or not, hysteria, if 
pnaeut before, generally passes away at once, so that va may safely 
attribnt« the b«(|iient pnlse to tho iavasion of another and motro 
■eriooa diseaae. 



8 



tai puLsr. 



In foTcra the pnlao is generally acoeleiuted in proportinD to Uw 
elention of ti^mpermtarc, tbottgh the proporlion between the palsaJ 
ftnil ionperatare \»riea in different fevers. In scnrlot f«Tor, tlw pnlM i 
is more Ircqucnt Uinn in typhoid fover vriLk tlie same t«mper»ttu«, 
Iwncc a froqaent pnlse is of lem serions import in Ronrlet tbiui la 
tjplioid fevLT. The suno t^ovUion of ieinpenttarc tvcc-elonttee tlie 
pnlw relntivdy mnoli more in cliildren tbun in iulalt«. 

If a pnlit) IK more rrv<[ncnt than tlie temperature Kill expbin, it 
indioatM cardiac wcmlmess — tliA vr«akn«n boio^ propnrtionnte to the 
want of ratio between the tcmpcratoro aud jnilae. In tbiH n-ny tbe 
pulM! iJfordif important information in prognosia and treatment. 

A pube tliat day by day progieaurely increasce in freqaencj'tJ 
the tcmporatnre remaining th« aame, shows increasing cardiaoi 
weabuiaa. 

In ail febrile di ac a a ae, a pnlse in adslts ov^ 120 is sorioos andj 
i&dioatca onrdino weakness, a pulae of 13(J or 140 indioatcH grvati| 
danger, and with a pnlso at 160 tho patient almost always dies. 
Tliere is, Ituwerer, a notable exueptton to this rule, in rbentnatia 
leror. In csliniiiting tho rabto of the ]iul«e in this disease, wo mnsbl 
caretnlly as(?crtain whi^llier rheumatic fever itaelf or periaurditi* 
occasions tlio incrcusod freqnoocy. A pnlse of ISO, if dne to tbo 
rhcuniatio fercr, indicates (prvat dan)^T. In snoh a cose the teni- 
pomturo is higb, 104 to 105, the patient is protrtrato, tho toogtMj 
probably dry, and aordea collect on the lips : a oaai; like this oftnJ 
i-nds fatally, and when tite pnlso rises aboTO I20, say to ISO or 
higher, tlie ixttient will pretty sorely die. 

If poricatditis causes llie froqoont pnlse, it becomes tlien of toe IsMi 
BOrions import, Uiough the pnlsu may riae to lr>0 to 160 per minnto. ^ 
Not onfreqDently wo moot with snch cases where, with but slight 
rlieamatto fover, aovero pcricurditia willi perhaps exteDsire eilusioo . 
sets in. Tbe t«mperataro is not greatly raised, rising only to lOl'i 
or 102* Fah^ tho tongue remains clcnn or but slightly co*(ei]. Nowl 
in a case of this kind, though the beats ri&e even to 160 and tlis 
pulse boconKW very bad in other qnnlitieo, being very coropmaiible 
or aren small and compressible, yet we m^r reasooably eipeot tbe 
patient to rccorer. The boart's snbsUnc* too Is gonenlly inflamed ; 
and this woakening of the beart'e substaaoe, eonpled with the me* 
chanical embarrassment rising from the pericardial effutuon, cxuitevj 
very hurried, oron panting bnathing. Thna attacked, the patian!'] 
oflvn looks very ghastly, ibe Am* boceinoB dnaky and di*turUKl willi 1 
tlio htdsona risus aardoniens ; yet if thaw symptoms can be clearly 1 
traced to tho cardiac miacbiof, wo may bold a weU-groundod hope <^ 
iha patient's neowry, even without the aid of tai^e dosM of alcobulio J 
itimulaats. In fact, ocuto |wricanbtis is raroly immadialoly fatal (J 



Tsz mat. 



9 



* 



I 



it rcmotelf (Jtstro^M life oitlj bv lending lo dtlHtntion with ralnitar 
iDOontpetencf, or to fatl^ degeneration of tlie lieart. 

BheoniKtio feror with other oompliaitioiiK gvnontlly ends farottr* 
My, no matter hoir scriouB ibo aspect of tlio patient. Pucnmonin, 
•ven wlien doable and furtbi-r complic&tcd witli extensive porintr- 
ditis, aeklom destroys a patient 

Again, an im^tar pulno &om mitra] disnso may bo veiy frequent, 
130, 130 or more, without indicating extmoe danger. SoniL-tim<!!(, 
in aontd ferer, oa typhoid fuvcr, thongh tlic tvinpcrrnturo i« high, the 
pabe raouins normal throoghout the attack ; such a pulse cei-uunly 
■lumv abaenoe of cardiau weaknest, and i» of coiirsci a favourable 
sign. 

In cbronio diwcaanii a fruqnvnt pnlso wry gimonilljr indicaica 
caidiac weaknesb 

With increaaod frvqnoncj other tigag of cordino woalcncM aro 
nnociat«(l. The weakened beitrt propcUiag tlie blood less euoi^eli- 
call}' than in health diminisheu arterial t«iiKir>n and the pnlKi: beranm 
>oft and compressible. Kelaxataun of the arteries plays a part still 
mora important in producing a comprMxiblu pulmi; thiK condition 
permita tha blood to ]>aKi with greater readiness into (lie veins, and 
so to leaeoQ arterial tenaion. This relaxed condition of the artorioleti, 
unleas the heart ia vcrj weak, uauHtiH the pulsa to be large and 
volumtDous. At firet one mi<,'ht erroDCOu»ly sappoio tliat thin pnlse 
indicated an encrgotia arterial cironlation and a well-beating heart, 
but the compreeeibility soon carrocl« this vrrnr. It is tburffora 
higfalj- important alwaj-a to toit the compresaibility of the pulse. If 
the heart becomes still more weak, and the arterioloK still more 
relaxed, then caeh heat propel* little blood into the arteries, and 
tliese allowing the blood to pass readily into the veinit, the pnliio 
1»C0DM!« small nM wttll an c(nick and compreaaible. Smallness of the 
ptilse, tberefoi«, indicates still greater weakness. When the pulne is 
vnrjr small it is luid to bo thready. When the heart is weakened its 
eootractiou often becomes sudden and sharp, ropidly reaobing a 
maximum and ra]>idly declining, giving rino to a quick pulse, which 
thoa often gives eridence of cardiac weakness, especially when com* 
bbied with the other and Hnrer indicationn of this stfito. 

Tberafore, in estimating the condition of the heart, we pay regard 
to the (nqneocy, espooially with rcferonoo to the temperotnre, to tho 
compneailMlity, and to the sixe of tbe pnlse. The more freqnent, 
the more compreuiblo, the snit^llcr the pnlse, the greater tho cardiao 
veakseas, and the more imminent the patient's danger, and the 
greater the need of cardiac stimulants. 

Tbeee pnlse signs, therefore, bulb in febrilu and uou-fobrile dis. 
', an indioatiOBS for giving cardiac stimnlante, especially alcohol. 



10 



rmt ruLut. 



^ 



TbMB piiUo tigaf, moToovar, afford ftn Mcimt« index of the effects 
of iilvobol and of tke unonnt roqaiivd ; for ftleoliul strvngthdns the 
dubUiUlMl heart, mlaova tho freqoeDcy of its beaU, and contmcts tlie 
YcuoU, luul so heightons arterial toniioD and lonwns tlio oompraa- 
nbilitj- of llo pulxc. 

Biith ill iicutoniid chronic affoctions cardiac WMknms is, aa a ralo, 
HMOlBpaiiie^ by evidL-nco of general wealcness, tkoni^li this hj no 
mcaiu is alnaj-B tho cue. We mnj ko called to a patient witii an 
acute illncaa who al first si^ht ahows no evidoaoe of weakness ; his 
tuajMnkturo is found to be from Hrl' to 103' ; h« ooxilj tnma over or 
aits, ap ill lied ; hi* voioo is straoK; hie tongue moist and bot littia 
faiTMl, pcrliapB evon clean ; he IaIcm bis food aud apparently dtgctfU 
it woll. Ue sleeps well at night and is fro* firoia dalLriam ; la ^t 
the gVDoml appoanuico uf thu patient iodicates no dani^ i b«t tlio 
pnbo beats say 130 per niiuut«, and it is araaH, oomprossibhr, sad 
qoiok; and not duo to oxcit«mcat, na we ascertain hj repeated 
obsanwtioas ; in tool this patient is in oooaidemble danger. An wa 
to pttjr regard to tlie pnlsu or to the geneml condition ? Cortai&ly 
to the framiD^ poise, for in a ea»e like this, jast described, serious 
•ipnptoaui will set in in a few <lnj-s, and the patient will sink, 'llio 
pulse here is a mnofa prompter and surer danger^ijpial tliaa the 
other H^mploinB. To take another instanoe;— A febrile patiout 
when first sseo presenta no serious symptoms^ bub as the caae gees on, 
and whilst Iba patient's general «tat« renutins apparaatfy satisfaotorjr, 
ihe pnke gtadualljr inoreasos in fnxinonof and loses iu forcr. Hero 
again the pulse is the better guido, giring oarlj indications of 
approaching general proatntion. 

Wc must, liowever, Imr in mind that owing to indindnal pecu- 
Uarity, the pnlw in »omv i>enioiM is oenljr made verf frequent, and a 
uodarato amount of feyer mnj- accelorato the putso and make it ]3i> 
to over LSO, witbont ibiit frvqucnoy indicating anj danger. Oar 
preiioua kuowl«d|^ of the |iatittDt will alone enablo UK to rightlj 
ealinuUe the fretiuenuy «( tliv ptilM in thsne qsaai. Again, wo meet 
with cases of this kind : a jiatiunt salfera fnna a ouidonitelj soTere 
attack of ferer, and the pulse is hy no means rreqaent in proportion 
to thu fnver, bet It is verj' small and very oumproasiblo. In formiuf; 
our pfogitoiiis am wo to bo guided hjr the smallneM and oompms- 
sibilitjr, or the freqaracj of tlte palssP In noel cases oertninljr bf 
the tntpioBioy, The wto and eotnprossibilitjr of the pulso varies in 
health very eoniidenthljr in difleroai persons. In souie innsons in 
perfsrt hoalth and capable of rtgorona ujwrtioat we find a very small 
an<l compntaiblo iKilse^that might oven ho called tbnadjr. 8nok a 
pulse oftan oeenn iu various msmhors of the same (aniiljr. Now if 
«uoh a iMinoa becomaa febrile Uw pnlsa beoomee more fnK|uunt, and 



THE rcux. 



11 



' vithtmt snj cardiao weakness is of oaarae «mal1 aod coraprvsHiblc-^ 
and ii is obvioiu if wo disregardod frcqaenoy and \md atteotioD oulj 
to ibe n>a and compmsikUity, wa sbonld be mialod, both as ragnnh 
prognoiia and treatnivnt. Of cotino oar previous ktiowlD(l|;o ooo- 
cemiiii^ llie patient vril], in nuuij iusttuiuM, mve. ns trom falliiiji into 
error ; bat Hboold we soo tbe patient for tho tint timo in a febrile 
attack, if we regardad tbe aize and compressilnlitj ratiter tlian tb« 
fmqnencj, wo aboald probably be mialed. Of couno if a provjonaljr 
^ood poleo beoomea small and oonprvMible this change is signifleantt 
but it mroly bappons ttiitt this chongo occara wilhont a con^tipotiding 
I increase in tlie ]>ulse'a frequency. 

It is true that somctimm signs of danger arise first in otber organn, 
[perhaps in tbe nervou system, in the form of BleeplosBDOu and 
, delirium, yet, as I hare poiolfid out, ma long as tho pulse remains 
good we feel that our patient is comparatively sate. If the norrous 
I pertttrbalioD nnthor spontaneoDiiIy declines nor yields to twatmenl, 
I the palso will nlUmately fail and Iho patient will «inlc. 

An infreqaoat pnlao occurs in somo cases of blood -poisoning, as 
in janndice, tinemia, and in theae cases the lomporatorv is often 
sabnorma). An infrcc|iicut potso is met with sometimes in fatty 
^ dogenenttion of Uie heart, and in aortic obstruction, in irritation of 
TaguB or ita root, as in miiningitis, cerebral ttunours or com- 
pression. In defervescence, the frequency of tho palso may bo much 
tdiminiahed. Tli« pulse grows less frequent in old age. 

In an intermittent putn, an oocaaional boat is missed, the rhythm 

Jbuing othera'ise nguhir. Tho-omittod boat may occur frmiuunily or 

I nnfrcquL-ntly, at an eqnal or irre^lar internal. It must bo clearly 

Ttindorslood that an inli^rmitt'-nl jiuUe is very different from an 

limeiutar puUt, and Iiaa au alluRi^thur different significance. Some 

Iperaona have a tife-long intortnittent pnlsu, but ordinarily, it does 

not occur till after middle age. It may l>e [x-raistcnt or oocasional ; 

when oeensionjil only it is oft«n duo to an idicisynorasy, and is 

ta8«d by some articli' «f ftmd, on ten, perhaps green tea, smoking, or 

ndigeation. Ccrtitin palienta are nnoonscions of the intennimion, 

: Bs Dr. flnwdbent points out, thi* ia espemally the case when tbe 

F intern isiiiou is habituiO. Other persons aro mode wry uncomfortable 

and ncrvona by a aenaation as if the heart stopped or railed over. 

The ininrmindnn often occui-8 only in the artory simoltanoonaly with 

,a wfak beat of tho lieort. 

mo«t ewoa an intermittent heart is of no significancts and does 

Bftpear in any way to imperil life, tJiough l>r, Broadbcnt states 

at m patient m affected snccnmbs more readily to any illness ; when. 

T, aHOcialcd with unixinivocal evidence of heart disease inter- 

ittoncy is of more sorioaG import. 



IB 



An irregnlar tit of fu- mora EcrioRs BignificMiiOO tlian lut iiitcnaitU<nt 
palsr. Tim pulse is frregnhr both in force and riiytbio, Bncce«i]iD^' 
beats differintr in length, force, and chamcl«r. It i» generally daa 
to mitral and ratvlr occurs in other forixu of heart disease, though 
GometiauM met with in grrat mtdiiu: proetntion, as in un ncnUt 
fobrilfl iUneas a few bonn befun? iltAtb. It occurs too in fatty de- 
^n«rul)Qn of the heart and in the first and second stage of nuningttis. 
It nay bo called tiM mitml poise, and gencrully indicates the need 
of digitalis, which in most inslaaccs leesoos or mmoTcs tho irrsgn- 
kritr. 

Whilst an irregnlar pnlse almost always indicates mitml diaeaM, 
it must be borne in mind that ■ perfectly regular pulse may acoom- 
pany extcnaive siitnl disease; either obetmctire or regnrgituit, or 
buth combined. 

Samo kotd At tbc okutcbm ot Imgolsritr la nilnU diMMt ij > ng» ot •ItOs^oi 
lonptiUBtloD, Ifaa ooDprMstioB being luuSdwl to mwt U>* alMnieileD to tht ditals- 
lion offertd b; lli« mUn] diMSM> Bat ■«« Uiii Tita osrrMt. lie« iIm* it iMppM Iksl 
s Um doMs U dlghalb >lll la Bstgr omm rMMn naokritr. lui thai «itk Us Hun 
UsosBM of lb* iH|tltli* tbt Innsiirigi don not Mom I 

The irregular pals* ia very rare in children under tweiro, though 
Uie conditions which produce it in adults are well mailed. If, say, 
botwcvn kix and Keren, mitral disoaec ia cetablislwd, and tho child, 
thongb inSering from its effects Htcs till it is over twelvS) tho 
iiit«niullenoy then Ivx-ntncs gmdnally developed. 

Tboogfa imgnlftriiy fmni mitral disease is ran in children, yet I 
bare seen aconite, in lialf-drep do*o» ro|>catcd hourly, sorcml times 
pndnee marked irregularity of the pnlse. Irregularity of tho pnlso 
in ehildnm ia eommon in iIm first and seoond stage of tubeienlar 
tBemiBgilto ; in fact its existence is ufion a rnlnable diagnostic guide. 
In some cases of cenbral diaease, with C'licyne-Stukve bruathiug, thi? 
puhw is affected by the respinttiont ; as theao grow mora and more 
sliallow the pulse grows slower and slower, and then becomes freqaent 
when the patient takes a deep sigbi&g breath. 

An irregular pulse mny bo duo to much smoking and to venerosl 

nXGBH. 

Ilithnto I have referred to thedupendence of the pnlse exclusively 
or mainly on the conditMm of the heart Unt the condition of (he 
blood'Tflasela thomselvee als't influnncos (he pnUo. 

ThruuKh thii aotiim of thu raso.motor nerves on tho masoalar ooat 
of tho arteries, tho imiall Mood-wseolN undergo relaxation or conUnc- 
lion. Wbra th* rossola aro relaxed the Uood passes nwily from the 
arteries to ths tmiu^ benoo arterial Ivmiiun is slight, nsd the pnlao 
is soft and ooMpflMlbla> but owing to tho rvtaxod Ht«t« of the voaela 



THE PtrtSB. 



13 



it ia also Urge. A relaiud condition of Uie arteries, tlicrcforo, pro* 
dnoes a large, soft, oompremible pulse* 

lu most diBooses, n relaxed oonditiou of the Artsrioi is associated 
nith a weak heart. SoiDotimos, howoTor, we Iiave arterial relaxation 
with a normal heart, in wkid) caao the pnlso is soft and oonu 
proanblo, hat largo. Thi« ptilso is met with in the earl; stage of 
SDm« fever*. 

Arterial relaxation, or, in other words, diminished arteriai tenaion, 
produ(H:s dicrotism. In this pulse one of the normal secondary 
waves of oMitlation heoomea greatlf estaKS^tated, so that it can be 
caail; fdt by tli« Hngor. Tndec^d it may ho so distinci that an inoi. 
periencied person mintaking it for Lhe primary wave, might easily btA 
lod orroDCotislj to think it indicated a cardiac contraction. Indeed 
a name liaa been known to make this mistake and thus to doohle 
the nnmbffr of troo pnlsations. Dicrotism alvrays indicatos marked 
arterial relaxation, and often ooiuuides. with cardiac weaknessi 
Some writers insist that this pulse indicates the use of alcohol, 
which alionld he pushed till lhe dicrotism ceases. Now, in thia 
opinion 1 cannot ooncnr, fceliDg convinced that in many cases with 
marked dicrotism no alcohol is needed. We must look rather to 
the fretjaenojr of tho pnlso, and if this shows the n«od for stimula. 
lion, then no donbi dicrotism affords additional oridence in favour 
of giving alcobol. 

A pnlse not very frequeut, but dicrotous and compressible, occur- 
ring at the commencement of a fever, does not nectiasarily indicate 
the need for alcohol : but this state leads us to expect that stimula. 
tioD may he shortly mi^nircd, and warns us to watch our pationt 
oarefttlly, im> as to anticipate and to prevent the oncomiDg of proa- 
tntlion. A dicrotoos poise ia froqnenlly mot with in typhoid fovor. 

I now com« to the pvUe 0/ ki-jk artarial letition; here the veiuti-lH 
are much contracted, and then as tho blood escapes with greater 
difficolty fn>m the arlurios into the veins, the arterial tension be- 
comes high. In some of tlie following rvmarks, 1 largely borrow 
from Dr. Broadlwnt's valuable lectui^s on the palse ; and the ])utsc 
in qaestion cannot bo hotter described than in his own words : — 

" The arterj', usually rather small but sometimes large, is Iianl 
and conl-liko; it can he rulled nndcr the finger and is easily traced 
in its conraa up tho forearm, where it feels tike another tendon lying 
amidst thoae in front of the wrist. It reminds one, as I have often 
aaid, of the vaa deferens." 

With the vuMM-'U in this condition the pulnnlion is often so slight 
that it might readily be mistaken for a wt-ak pulse, but that its in- 
evnpnssihility prevent* our falling into this error. It can be com* 
praoed only by using considemblo force. It is, in fact, a slightly 



14 



THB PCLSE. 



polntile pnlw. for owing to tbo higfa &rteru] tenrion tha TCMtd with 
cftcU bent of Uie heart nDdert;oo8 bat littlo dilatotUw, Iimmo tho 
polaation is iodistinct. In nddilJon to being sraoU the pulM U «loir 
sad lukid. 

Tbe folloiring conditions give ri»c to nrtonol tcntion — ■ 

1. DofTOnnnttion of voiada. m 

'2. Kidney diseftse, ospectMllj^ tlio contntctod kidney. I 

3. Oont, janndioo; Icnd-pottoning ; ergot; gnllicficid. I 

4. ASections of tha norroBS sjrsteni. ^ 

5. Th« rigor of feron. 

High ftTt«rial t^nwion nccompnnies eoni« forms of Brigbt'a dianwv, 
occarring in the tattv, bnt mpccinllj in the acutely -in tluned nml 
controct«d kitbtcy ; iti foci high ut«rial tonsion, nnd hyim-lmi>hy of J 
tb<i heart, UMOcintcd with an iniTwinil quantity of nriniuy wmtor' 
containing a small quantity of ftlbnmcn, nutblo ns to diagnose tlui 
oontroctul form of Rright'a dtsooM. The albuminoid kidnoy is not 
nui>cinto<l with high artprikl tmision. 

Allhongh it IN qnito tme that, in grncral, a eaft ocHnpressibltJ 
pulse of low tenBion accmopanicK a weakly acting heart, we meoM 
with exoeptions to this rulo. For a pkticnt prostrate, nay, evMii 
moribund, and oonseqnently with a very feebly acting bourt, ttafi 
bare a high tension pnlsc, tho radial artery feeling hard and riM 
maining to the tonch like a firm cord, nnd is distinctly traeenbiM 
■ome wny np th« foraaim, even during diastole; whilst tbo t«m>l 
pond artery is also 6rm and resistant. This combination of a higbl 
teaswn, and tbervfore email nnd ntsistant pulse, with grvnt c-ardiao 
uid gmeral weakneM is, I think, more conuaonly twen in childrnFn, 
and is soniotimra Btrongly marked in tubercular meningitis and 
capillary bntnehitis or broDcho-imeomoBia. 

It is obrinuB from these Wts that we most not bo led to giro a 
too rnronmblv opininn boeanM of tbo high tenaion pulse. When thn 
frcfiuenoy and Uie tvnsion point in opposite dircotiotis we mof^t rely 
on (he freqnenoy mther tlian the tension. In those cams when^ Umm 
hnnrl is fc<>blo, though the pulse shows high tension of the v«MolrvJ 
wu can, from the feol of the ]>nlMe sometimes detect the oonditioQ ofl 
the heart, and thna i-8l4mnt« tlio Ime state of thu patiuiit, withouH 
having nganl to lhi> frv(|iieiM!y of the pulse. The pulse, ei'en dnrinM 
dlaslole, f>«els har«l and reeistant, and we mn tmco it a long distaaoM 
beyond the point wlufnt it is uiunlly felt, hut each systolic distoasdoiH 
feels smaller Ihnn nsiinlly, ercn with high tension of (he TtaaslaM 
DMMvover, with sliglit presanre, we oaa easily arrest tbe pulse-wave 
along the <r«BMl. 

UoTB, pnrhaps, I may profitably in(rodac«, thongh at the risk oM 
HVM rspetltioB, an account of the m odiS o tiooa the pnlM nndergoot 



IHK PCI^E. 



15 




'in die Ettajrca nt an acnte illnesa. First I will refer to tLo characters 
of tbo ]iat*w of A ni»n prcvionnly rigorous ami n)bu*t Kinitt<m with 
an acute di«iwe. Tbo pulse dilTors in tbo separate stages of tbo 
,fp«!r, in tlw chill, tbo iiom«, and th« dcoline. During the rigor or 
chill tke arteries oontmct, and prodnco a pnlso of high arterial 
■on. Tbo pnJwo is froqnent, email, often very xmall, hard, int-'om- 
aUe, and lonff, or as it \s otherwise termed, slow. The chill 
rer and tbo fewr cciablishod, the artcrioliM relax and tlic [inlw 
sea larger ; but as (lie heart is not yet weakened the pulse is 
fnU, and not usilj ooniprM!ttd,-~<bonnding aa it in called. 
'"Ulien tite lover pernsta durinf? many dajs and tbe patient grows 
weak, the pnlsa baeomes softer, and more compressible, short (or 
quick) and oftiMi diorotons. 

In thucBM of a fever with great prostmtton the pul^ is very 
frequent, small, short, very compressible, these cliamct<'r!t iNti-nming 
atill mora marked if the illneea terminates fatally. If in ihu 
mppoeed case the patient, prvviouNly in wonk liealtb, in nnddcinly 
altaoked witli an acute illness, the pulse from the first would assume 

• this chatacter. During th(i dvcline of the ferer, especially when it 
Cnda nbmptlr, and accompanied by free sweating, the pulse, unless 
tbo ]i«tient has been grently wmkunml, in Inrge, very auift, csjuly com- 
pnMiwd, diorotona, and short — all the characters, indeed, of extreme 
arterial relaziUion. Imlettd in febrili; discaecji, even during their 
lieigbt, and in non.febrilo discttees too, when the skin perspires 
fraely, lliia i> generally the cliaructer of the pnlxe. And this also is 
tho pnlse of acute rhoumatisu), boeause this disonao is usually 
accompanied by Kwcnting. Again, in a febrile disease, when by moans 
of a drag wo convert the dry into a moist skin, we find the pnW 
^nbccomea noft, largo, but compressible. 

^B In woll-marked aortiorvt^rgitaiion, the pulse isoft^ncharactoristJo. 
^En tliiH aJfivtinn tbo blood during diastole flows bock into the 
^pentricle, so that tho arteries become more or less emptied of blood. 
^Hlifl ventricle being hypcrtropliii^d and dilated, propola a larger 
^'uniintily of bloo<l with greater force than usual into the partially 
cmptii-d arteriw. and suddenly distends them. This explains most 
of the phenomena (if the aortic regnrffitant pulse. The pnUe in 
^^rtat nrtorial rolarstion may rimntato tbe pulse of aortic regnrgila- 
^Koa, for great arterial reUration fay unduly facilitating the poffage 
^Bsf blood from the artoriea into the veins empties the artoriM mora 
^mhan usual, &nd theae im611ed vetaela becoming anddenly distended by 
Vtbo normal contraction of the rentriclo, give to the finger some of tho 
Hfiharocton of an aortic regni^itont puluc, but tn a inuoh less marked 
^HagTW. Tho pnlso of aortic regurgitation is of two kinds, defiending 
^^B tha amoant of regargitation and the itrength of tbe heart. Tim 



puUo in rorl}' cases ftrnduntlj risM aa usaal till it reach«ii ila acme, 
and mddenly coltnpecs, Uio coltnpso being ilao to tbc nrgut^tAUon of 
tbo blood into the reutricle. 

In more adranccd cti«c« tho pnW ^vcr to tbo finger a sliarp, 
qniek irtroke. Th« extreme suddennesfl in (lie comincncenient of thv 
ptilse, as Dr. Ontabin obttcrrcM, ifivtx to iJtn fin^-r in marked caaea 
tbu impression of a snddtm blow or jar, This ia tbo dinfmostic 
qtiolitv'if Ibt! \tn\fte. In noma caao*, MpccUlly when tbo bcart is 
weak, ii sovoml llngurs iirc placed on tbo artoryi mid tliu jtrcNiure it 
gmdancod. ttifl pnlMO f«Gts at a certain degroe of prMntn as if a small 
bail or sboC was paffod nnder mob fingor. litis is the abotty pniae. 

Thia cbanu:t«r of pulae nu oft«n be felt beat hy gras]rin^ Ibe 
wriiit witb ibe whole hand, so na to feel both ninn and »diat urteriua ; 
and tlkvao cbaracten aro also increased l)y nuaing tlio wrist high 
above (he level of the bcart, thorob;F^ enabling gmritatioii to m^ 
the aortic ivgurgitalion to empty Iho arteries. This quality of polso 
ii often only felt when ft certain d<;g7«e of prowure is made on tbo 
artery, becoming mooh leas by dimtniabtBgor imcrensing this preasnre. 

In nurlic regurgitation, ns Dr. Comgon points ont, (he pnbo is 
often vixilile in the more conspicuous arteries. It bnnomrs far mora 
naible at tLo wrist when thu nrm ia misml over the bead. This 
visible pulHatioD is probably dne, as Corrigan points ont, to the empty 
condition of the artery dnring diiistole. The blood flows easily into 
the Teins, and raneli Is poured back by the aorta throngh the patent 
aortio oriSoe into the rentnclc, hence tbo imperfectly flUed arteries, 
on rooeiring the impaci of the blood from eaoh contractioD, beoome 
widely dilatod. 

Is visible pntsation diagnostic of aortio rrgnrgitation? Certainly 
not. Viaiblo nrtrrial pnlaation vf the neck and bnd accompanies 
not only aortio regargitatioo, but also fibroid degeneration of tku 
VtMeU, great arterial relasalion, and high arterial tension. Mere 
noltement, by inorendng the force of tlw heart's cnntractian, uftvn 
ia rnmias persona prodnow risible carotid pulsation, and this pke- 
nomeoon la more frequent in women. Itut tbia ncrroos pnlMtion 
mrely extends more llutn half way up the neokt and bencw can 
generally be at once detMled from the rtsibhi carotid pnlsntion doe 
to nM>re aeriona eauaoa. Visible pnlsaiion of the whole length of the 
eaiutid to the lobe of tbo <«r and of the ltfiDj><>in], an<l perhaps of 
tlie facial artesy, is far more rrvqiionlly due to aortic rfgnrgitatioo 
than to high arterial tension or to tlio opposite condition, low arterial 
leniioii, or to dogenomlion of tbo arteries. Therofore estemslYe 
visible arterial palsation in the nock, that is, wlum tlw pulssLion oan 
W distinctly seen as tar as iln* back of tbo lobe of (ho oar, is strongly 
•Bggestire of aurtii: rvgiirgitatioB i tbuugli I should mention that 



TDK Pri-SB. 



ly 



^ 



I 



* 



yi*ibl« pclmtion is woll mnrkod in pcricarditui occompiuiioi] by 
caniitu or pecicorduiJ eitusion, conditions gencmllf &asQci)it«d with 
marked kricrinl relaxation. 

Aortic r«)^rgitation, degtnemtton of tho arteries, and liif[h arterinl 
t«nsioii, will prodnco diKtinnt riNibl(> pulsation not only of the carotid, 
but likewise of the brachial, radial, nlno, &n. 

These til rco condition* — iwrtic rugiirg;ilalioD, arttniid degonsniitioii, 
and bifth arterial tension — may bo combinod. Aortic rojTiir^'itati on is 
oepcciklly n disciwc of middle or odvruK'ml life; tlio rntlg-nrtoritis 
ftnd endocarditis prodacing aortic and arterial di'geaoratiun beio)^ 
dne to Rgc and strain from sonto laborious occnpution. Tho chronio 
inflammabion often affects the entire arterial ^«teni even to tho 
smallest TMsels, and by rendering them imdastio, and by narrowing 
tbe lamen of the ampler veasels friotiou ia incivaaed — a greater 
hindraoco is offered to tho pacMigo of tho blood, and the toneion of the 
veKNclM nMM. 

How oao we distingaiBh between tho visiblo brachial pntmtion due 
tn nimplo artoriat dx^cneiation, and that due to aimple aortic rcgur- 
gitation P In arterial degenoration thr nrtcrirH tiocomo elongated 
and tortaonis eiuHly riiublG in the brachial just above tho elbow. A 
tortnona pnlse. tliOTtfore, always saggests arterial degeneration. 
Monorer, in arterial dttgonciutioii tho orterieti feel hard and corily 
eren when nil blood ia pressed oat of them, and Romctimefl colcaieons 
pUte« or athcromatotu hardctningn can be diHtiactly felt. A tortnoiu 
OODdition of tbe arteries, as of tbe brachial, does not, however, 
always point to dcgoncnttion, for aa Dr. Broadbcnt tvllsi me in con. 
firmntion of my own ejtporience, lhi» tortuosity muy be produced by 
liigh arterial tension, bat myM it occara only when high arterial 
lenaion bna endnrod for aoroe Itrae, and iw not neea in the coaca of high 
arterial tension accompanying acnte Bright's disoaee. 

Long ago. Dr. Corrtgan pointed out that raiaing the arm increased 
tho visibility of the imdial ptilsc in aortic rogorgitation, and he nsed 
thi* fact to support his (heoiy of the produetion of Tiaible arterial 
pulsation in aortic rogurgit«tioD. This increased risibility of the 
rndial polao on taiaing the arm will not, howercr, enable ua to ding- 
no«e aortic rcgaiigitation, for in arterial degeaeration the risible 
radial pnlao becomes decidedly mora nbviuuH in thia position, though 
perhaps notso great inadegrccasin woll-marked aorLic regurgitation. 
I nuy mention, that in childmi even with conaidcmblo aortic rcgnr- 
gilation the pulse is rarely visible. 

In many caaea of advanced aortjc re^rgitation disease, the ob- 
aerver'a ear ia placed in the patm of tbi- patient, rniited above the 
livvtil of tbo heart; i-atib beat of tbe pnlee is distinctly audible. In 
adTauoedcaaeaadoublemunuur. too, may bo produced by prenaingthe 





18 



THE PCLSE. 



Btelhosoopo on n Inrgv srtcrjr. This donblo marmnr » lieard beet orer 
tlis feinoral, jast &t Poapart'e ligament. Tho diastolic mttrmnr U 
cmly audiblo with & certnin dttgroc of [irontiru, luid is otteo quickly 
lost hj any inonase or diiuiuulion. 

In aortio rogurgitatiim tvo often mtvi with the capillarj polae. 
AiHieii the skin ia reddened by irritation, tho blnah pnlmtei 
synch rononely with thu hMrt's bonL It ti ohaerred heal in parts 
aittiat«d on a higher Itnel thnn the heart, as the forahead and 
tomporal ragion. With ouch diiutolo tho nkiu hecomea pal* aad 
reddens a^jain with ifae systole. The explanation of those changes 
is obviona. During diastole the blood flows hack into lh« ventriole, 
aad the arteries become lyimparatiTdy ampty. thoso especially sits* 
atcd nboro the oardiao level ; hence during diastole the irrilaUtd akin 
^rows pale, bat tho systolo again lills the dilated voMela. and a 
hlnsh (titfoscs itself over Uie skin. The capillar}- pal&e is also visible 
in the extremities, but is much tnorc marked when hand or foot ia 
niaod shove tho heart's level. This capillary poise ia well exempttfiod 
in the sole after reddeniiif; tho skin by putting the foot in hoi water 
or mnstand and water, ll is well broDght onl by wrinkling Xiut akin, 
by strongly extending the fool and fl«xtng the toes. The akin along 
tbe wrinkles boconiM pale, bat reddens with each systole. The 
polsation ia well marked even when the foot rest* Mow the heart's 
ICToT, for (ho wrinkles in the skin press on tho capillaries and empty 
tlkem ; but the systole is sln>ng enough to refill them and to redden 
the previonsly palo skin. As would ho oxpootcd, prosmira on the 
artery supplying the surface under ohscrration arrests tbe risible 
oapillary pulsation. 

Tbe pnlae of aortic obstruction, so long na tho loft ventricle remains 
nndegonomted, is slow, generally amall, infrequent, and often hard. 
It ia alow and small, beuause even the hyportrojihied rentriole can 
force llw blood bnt slowly through the narrowed aortic orifice. Il 
is infrequent because of the great length of each sysiulc. If there 
b oo-extsiiug inaufficionoy, of conrso the chnractcr of the pnlsa is 
mnofa uiodiAed. When oorapensataoD fails, Iho pulse becomes auall 
and comprsssiblo. 

In marked mitral obalmotive disease, the pulae, when not in-vgnkr, 
is small aad comprasaiUe. 

In arterial degeiioralion the vessels become elongated, lortnons. 
and the pnbe-beats heoomo very visible. The arteiy fcela ban! and 
like a cord, or like tho vaa deferens, aad aometimes the caloarouus 
platea may be felt ev<Ta in the ndial artery at the wrist. This ia a 
very siguiScant condition, being evidence of senile decay of tha 
nrterius, a condition which leads to atrophy and doKiuinration of tli« 
or^fans. Many ]>ereons are consli I nt tonally much older tliaa their 



T8B SEIS, 



19 



I 

I 



jrenra will it-arrant — tkoy ttre, in fad, promatnrely old ; vrbilst, on ths 
other hand, maay old people show few sigiu of old ag». In indi- 
vidnnlu |>reinatnrdy old the arterica arc found ia a 8tat« of dog«D- 
crat;on, whilat in halo old poopio their nrtoriiM ahow ton or no sigiu 
of dc^ncratlon ; It has bv«ii v«ll natd that a man ia aa old as his 
arteritis. 

Dr. Atig:nMtnR Waller denribM a " rocnrrent pulsation in tho radial 
arteiy." After Gompre§Hng the radial pulse and conipletelf obliter- 
ating it, hv points ont tliat in manj ciuwi the pnlsu iilill beat* at tho 
distal Bide of tlie ficgera. The arterial irave vbich prodnoes tbe 
pulsation, ho explains, coidch from tlio ulna artery and travels tbroogh 
the ndiO'Ulna inosculating arteries, and so reaches the radial artety. 
If the nlna artery likuwiiw la oompreaud, this jiulxatiun at tlio distal 
aide of the fingers ceases. This "recurrent pnltation" is found 
genemlly in penona with relaxed arteries, In whom the heart boats 
fairly iroU ; for a weak heart is nnnblo to propel a wave from tbe 
ulnar lo the nulial artery. Dr. Waller tiitdd Uiia rccorront pulao 
twice as often in women aa in mm. 




I moia 
m In 
KoIt«i 



THE SKIN. 



Tbb condition of the slcin afforda us a sorica of inHLructin ^fn^toma ; 
bat in tlus place I mnat rcetrict myself to speak only of a dry, a 
moist, and a profnscly wut uud xodden siciu. 

In most fevera with persistently high tcmporatoro tb^ skin h hot, 
oft^n pungently hot. Kow, if we make Uiu patient's skin coniforl. 
moists we shall considerably promote hia comfort and welK 
Imii^. Small often-repoated doses of tinctaro of aconite or tartar 
emetic or full doees repeated every throo bonis of spirit of miiidv- 
rerva, will indnoo peiapiration. Aeonite and tnrt«r <^nietic are the 
most BQcoesalnl ; in fevers without lung implication, aconite is best, 
hat in catarrh, broneliitis, or {luunmonia, tartar emetic is prefernble. 

In many cDsea of diabotes and Bright'sdieeaaetit isvery dilSoalt to 
make the very dry skin peri<pire. 

Tlvooccnrrcnco of sweating often suggests hints for treatment or 
lusists the prognosis. 

The two chief cMuea of sweating are weakness and a fall in a 
febrile temperatnro, two enuaesoften combined in tho same individual 
in exbansting febrile disoescs, as in plithisis. 

In a nou-febiila patient, the readineta to perspire often indicates 
wwltneea, and even meaauros iu amoant ; thus, in deproassd health, 

C2 



20 



TBE SStX. 



ft poTMn finda tlut cnurtioD, ercn alight eiertioii. or tuj ficitcnunl, 
oMiaM too fnm i w ei t ing. A tmin«r knows well tbftt a tninw u io 
bftd oondttiati wIwb Im> perapirea too freelj. 

Affttitt, in exhaasttng diBwiw. and daring the wmIcdms oI coo- 
valMcnuje, alight excrtioa, or avra sleep, prodacca awoKtmf;, often 
profoae. It mtut, bowertfr, be horae in mind, lluki in aonnd brklUi 
groat dtScrvneoii in rcapiwt to tlu) amount of Rwcating an m«t witli 
in diffnrvot indiridimls. A perwon mlnraia^ fran a reaidenen in « 
hot oltmnU where hi* akin li*i< hkbitnallv act«d vtsj tn»ij, finds on 
hi* retnni to ft GoUer climate thftt, nndcr idight axertioa, ha still 
oonttBBM to perspire rtrj na6ily. 

Pl<ofuae BwaattDgoccaradnnngthe irndden fall of a (ehrile teiBp«n< 
tan?, a* in theawefttinf^stagi-of apw,or<larini;ibi<fa1lof t«rap«i*t(iro 
after a rigor to pjmnua. Phthisical pnticnta, too, in whom th«re 
oeeon a groat dinnal variation of tempentnro, riong to 102* or 
higher at night and fallmg in the early moraiii^ baais, oanmonlf 
(Mdn^o with this fall a. drenching penpinttion. Ths anoont of 
sweating in fcln-ile caaes depcodnon the cxti-nt of the fall of latopera- 
tnre and the weakocM of the patient ; where thp wraknea* is gnat, 
tha Bwonting ixoftcn proftue, tliongh the fait in the (ewperfttnre msj- 
measure onljr two dcgraw or leM. 

Tbeae twn funoH of poTsptralion when Dnoombiaed can bo easitjr 
diHcHniinatml. KicejA in thocaaoof pjTHimia, ibnnoconnt in febrile 
tliBmM.li nnlv onco ddilj*. n rise and a M} of tcmperatnre, and con- 
iioqnimtly BWQftting when dau to a full in a febrile lemporatnro ocou* 
only once dailj, and chieflf earlj in tb(^ murning. In weakness, on 
the otiicr hand, Hwe>ating breaku oat at any honr, and manj timoa a 
(lajT, being oeoasionod hy exertion. *li<ep, or exeitement. 

In mj eocporimee, profnae sweating as a mlv iit mora comnMH and 
]»*tt hmgcr in the oonraleaMnoo from aearlel ferer than in other 
asBto fobrilD dionw ; lioooe during the raoovcry from soariet ferer, 
aadaniua in largo crop* often ooonr. greatly hastening deaqnaiaatioo, 
the skin somctimeti coming oS in Inrffn pntrhai. 

With the exoeption of rheamatio fever, profoso sweating at the 
oommonooiDont of an annto febrile diiieAae, when the temponlttn 
remain* poniuni>iii1}' high, indicntee great weakness and adds to the 
gnavily <>f llu- proginwiH ; wln-n with the profnse aweating, thera it 
duRkineaa of the face, ean>. and nnder the nails, showing weak oir- 
oaUtiim (ran anfeoltlcment of the heart, the senona aspect of the 
case ia stTsagthoMNl. Again, the feel of the akin shows the condition 
of a patient. With mnoh porsptratioD, iba skin soft and sodden, 
(loinlJi to {[eneral weakiuas, ft stato ftceompftmiod witli d soft, p«rhaps 
faui[e Luinniiwiilihi pnhw. TImm sigiu often indicate the oaod at 
■looboUo atinittlants. 




n 



82 



TKUPeBATUKE OF DIBZASB. 



THE TEMPERATDHE OF HEALTH. 

WiTBiS certain nrirrow limits tba bodjr maintauia its temperature in 
limlth, bat vritluu them limits the tompcntoro ^-»ries in a definite 
dftil}' e^rclo. Dnring the duj- the t«mpemtaro remaina ahont 99', but 
towards eveniuK it begins to ia.il, a&d genorally feochos its minimiua 
at midnight. At this point it nrnuiina atc-udy during a few hoe 
and thvu begins to rise, reaching its nuucimnm abont 9 a.m. 
diagram of tl>e teinpomturo of a lad t«-v)ve fears of ngv illnstTatet 
th« dailj ooTtne of the teniperaturo in hoattli- 

The chart shows at once, that a lompcratnro normal during the 
da}' would be abnormal at tiiglit, and eic« vend. 

Daring the day, Iwtwwn it a.m. and 4 r,«., th« healthy tomperatux© 
is usually about !>!>' ; thus it may not be higher than 98*. or it may 
rise to 99'5* Fab. Any rise alMvo Q9&° conKtitntca fever. About 
four in the afteruoou the evening fall begiiis, and at midnight Ou> 
t«mpenttan is about 97* or croo 96* Fah. 

WMIn Is muijr lobnit tdnit* Ilia Uinp«ntim mm tli« wme mutn m to diUdnn, rM 
wtib Mbtn ihg eonraa ii mDnrlOit modiSKl trom thnl jnit dworibed ; Ihua lh« ititj 
<j«lga ttv Bstn coD^iUnbl^ Iho lOAcinaai Unt<«r«lnra mud Iha crtninc Uli babif ta>. 

In persona under 25 the daily variation is 2* Fab. ; whilst tbo 
variation in poreons over 40 >* more mtrictod, beii^ often only 1' or 
even less. 

Jaogar finds that the daily variation ia greater in porcoos whilst 
labouring than whi-n at nwt. At rest he finds the average daily 
variation to be 2 '2, wbitat doriog hani physical work the daily 
Turiation amonnta to 47. Hia exporimcnta wore made ou soldien, 
the obenration being talccn in the roctom. 



THMPERATUltK OP DISEASE. 

Wbiut any elevation of temporaturo above 9d'A* indicates dti 
it need hardly be pointed out that a normal Icmperatore does 
nncBirily indicate health. Uany diaeasee. Ivolh acuto and chraaieT 
dnrii^ their whohicoBiMa ara unattended with fever. Indeed, in 
aomo di Willis, tbo tomperatBre ia deprossod beknr tfaa hooltb stan- 
danl. 

The daily course of feror varira with tbo severity of the diaeaaa. 
In a mild attack tbetv Is a oonRidetable diuraa) rariatioD. the lera- 
pamtanrking towards night and AJJingin the early morning houiai 



TCKPSRITGRE Or TSTtJIt 



23 



! bat in ft scToro MtAck of febrile illnoMt tho diarnnl roriation muy 
he very aJi^ht or eron Absent, the temperature remaining persistently 
high. 

In priratfi practice, aa a role, it is oonvonieDt to m&lce bat tiro 
daily obsorrationg, and lhe§o shoalil bo taken at kticH tirnos as to 
obtwD tba higbest and lotvost t^mpiTttturu of tie day. The likeliest 
timu to give than miaimnm and mAximnm temperaturas are 8 to 
9 X.U. and 8 to 9 r.u. T)iou(;h m a role thu ronmtng temporatnro \a 
lower than the evening, in rare cneen tho rovorae happeuB. In some, 
especially in chnmio oaacs, As in pUtbiau and wmotimos in mibncnto 
rlicumatism, the fever may last only for a few hours between 8 a.m. 
and 8 r.H.> and Uina obierrationii taken at thew timm, thongh tlio 
t«mporatnre ia then normal, do not absolutely prove that tho pnttent 
is foTwfree. If only one obaervation daily in made it nhonhl )>o 
tokun in the oroning, as, oven id ihe diseases so seTcre as scarlet fever, 
the morning tempontturc may bo nearly normal thrungbont the attack, 
whilnt the evening tomporaturo may rise to 103' ; hence a moniing 
ation only -wonld K'ad to a great mistake oonceming tbo 
rity, and possibly tho nature, of the illneaa. 



I 



ABNOBJIAL ELKVATTOS OF TEMPERATURE, OB FEVEB, 

CoxTAOiOUS and inHnmmatory discftsos are accompanied by a riee of 
ti'miiemture, which is not only dependent ou, bat proporlianuto to, 
tho activity of tho nttAck. In oUilt fulmlo discwscs, non-contagious 
or non-indammatory, tbe tomperatore U also pniportionatv to the 
activity of the disoaM ; bence the thermometer is tm accurate index 
of the amonnt and intensity of the inflammation and of tlie Mcvcrity 
the attack. It mnst bo borao in mind that the same amount of 
produces in children a relatively higher tcmpcrntnri: than in 

U, and that there arc, moroovor, probably individual or family 

peculiarities apt to raiao the temperature in discaso beyond tho 
ordinary HtAndaid. 

lu forming an opinion on the conno a caco will run, and whether 
it will end in rwwvery or in dcatb, wa must not trust simply lo tho 
height of tbe temperature, for it in obvious that the issue will de- 
pend not only on the severity of tbe attack, bnt also on the patient's 
ability to resist the d)scn*v. Therefore, in estimating tho dangvr, 
whilst wo mnst regard tbe temperature of the patient as a measaro 
o( tho severity of tho attack, wc must consider, too, this general 
oondition of tho potiunt as nuinifeated by the utate of hid heart) 




21 



TEMPEBATDBB Or nVEB. 



nerroiu ^Bt«ro, atoiiiacli, &c. To i)liistmt« this point tAke two 
ordinary nitce uf tjphoid terer, Oae pntiont willi high teraperKturc 
tokeftaad digests lii> food fnirljr well ; (^"^o is but little diarrhcra. 
h« ileep* well, his lioart is not much we«ken«d, nud jrot, in Hpilo of 
the high feror, or, in othL-r worda, tbu aovcril}' of the attack, h« 
nakes a good recoTorr. Another fatient, with dMidodly Ivm fover, 
is troubled with aickncM, diarrhon, slooplemnoas, dtilirinra, and weak 
heart, and to, thongb hia attAok oa indicated bj the tempentvre is 
not serere, yet be dies worn out. Again, take two OMOS of phtbiiiis. 
Odo patjent, tn Mpitc of conHiderable daily fever, eats, digests, bimI 
■Minillalcfi fairly well, and for the most pari niaintaius his gmond. 
Another patieut, though bia ferer may be slight, and indeed somo- 
ttmes even after it has becoiae normal or below normal, the appetite, 
digestion, or asnmilation being greatly impaired, slowly bni surely 
wastes away. In certain mro cases, though the appetito in good and 
the digestion is apparently well performed, yet if aastmilation is at 
fault the patient, in spite of plenty of food, wastea away, eren in 
oasea when the temperature has become normal. Hence in a case of 
phthisis, in addiliuu to the fevn* unil the appetite, we muMt note the 
weight, for in a case where plenty of food is ingested but assimila- 
tion is dofivtive, the patient's weight is the sole rocasuro of bin pro- 
gnss. We must, too, pay attention to the condition of the bownls, 
for witli much <liarrh(i« the patii-nt quickly dcvlinea, even when the 
ferer is but slight or has eren oeaaed. 

tl may be naid, porbugw, tbat the Myniptoms — the general woakntM, 
the frequent, focble puUe. the loss of appetite, and the delirium, are 
duo to the rlevation of the temperature; and this remark no doubt 
is trae, for by treatment which tends lo rMluce the tumperatore to 
tho normal standard we can abate or remove all lh««o symptoms ; 
and the abnormal elevation »f tcnip<-rAlur(! not only immedialrly 
depnuM* an<I weakens all the bodily functions, bat in proportkiu to 
the height and duration of tho fever it likcwiKO |trodueea dcgencra- 
tion of all tho ov^gias, and this defceneratiou gnnlty noakeiui the 
netivity of the or^Kim. If ttia Kymptonui are all refrrnblii to the 
direct dopruKsing effect of the fever temperature, and indireetlj 
through the degeneration it prodncvs, it would serm a plausible tU(K 
position that (he height of the lempvruture should be an exact 
measure of the jiativnl'ii <l«iigiT. A tittle rvlloctkm will soon show 
that this is hat partially true, for tliungh, do doubl, most of the 
■yniptoina oriMi fnim tlie high totnpeiatnrs, it msst bo rraoUmletl 
that its deprciwing <'ttect must greatly depemi on the prvvioaacun- 
tlition of an iorntli'd organ ; thns, if provions illnoas, ei e ws i i of any 
kind, or unliygimiii i^iuditiona Itave alrskdjr depressed the organs, 
high tomperalon will tailiot on tbrai maeib gnrsr mJsohisf. If, for 



TSKFBKircriU OF TKVEK. 



25 



^ Tl 



w 



esamplo, rboasiAtio fovcr biw slightljr diunngod tbo boart, a tobrile 
ftttaok will ooooiderablj- increase Ui« dangers to the patient througti 
failnrQ bf tho hmrt. If intcmpoinnco ban injnrcd tlio ncrvons 
«jrKt«in ft te1>ril« disease will intenaify the danp^>r of delirium and 
deproSBion of tlio nerrooa iijrstoin. We cutiinfttc thu renatirv power 
of (iBCli oTgtM bj liie HTeritjr of ita sjujitoma iu eompariBou witb 
tli6 hoigbt of tbe fever. Thua, if delirium is oxccmito, whilst tJw 
tompi-intare i« but *ligbtl/ elevated, it allows that tliv iiRrrous 
syiit«m lias but little power to resist ; and if tlio pulso becomes very 
freqiMat, Hmatl, and compnisiiibte, it nhowa tliat Ur* hoiirt's resist- 
anoe is but slight. If, on tho other hand, with the fever severe 
nervoas Rymptonis are alight, and tho pulae, not vorj fTeqiiitnl, is 
full, and not very cctnprossiblo. then we conclude that tho condition 
of the oorroitt oentrcn aud tlie lie^rt it aatisfactury and our prognosis 
is good. 

Thorvrorc, in catimating the dangcrn of a febrile attack, we mast 
regard not only the intensity of the disease, but tbo resisting foroea 
of thu body. The tvmjHiruturu laeoHuriM the intensity, bat tho 
power to resist fcrcr is oetimatcd only by oarefnl attention to thu 
condition of tho dilTerDnl urgnns, eopucially the heart, tho brain, and 
the stomach. 

Uoea the conno tlii) tumpniaturo runs givv vvidonco of tho natore 
of tho disease ? Whilst, on tho whole, this question must be 
anawoTMl in the negative, still it Diniit Ik: renin inhered that vortoin 
iliHWliinn generally have a somewhat characteristic tempo rat ore ; 
indeed, in many cases of iigue and pyiemia tho temperature itself is 
diagnostic. 

Tbo tJwnaomator aesisto us in diagnosis in cuoe of tho following 
kind : — A. patient heoomes ill, and the temperaturu is found rained 
vo the bcullliy sbindanl. Thin faot, r^pocially if the lempeia- 
i> high, makes it incumbent ou the doutor to search carefully 
to di«ci>ror its caase. To narrow tho nnge of our instances, lei ua 
restrict our attention to the commoner eausos of fever. Tim fover 
tnsy be dtio only to tho acsto contagious diseases, acute itithuama- 
tioa of somo organ, rheumatism, gout, or to the disonsoB causing 
chronio fever. The doctor, we will suppose, has been collud in on 
the first day of tbo attack, and his duty is carofolly to invcstignte 
whether tbo fever is due to inflammation of any organ. In most 
iii8tanc«s the symptoms and physical signs will enable him to arrive 
at a diagnosis, an attack of rheumatism or gout being so oliamo- 
teristic that ho will detect either at once. If the fever cannot be 
tfauA ttoconnted for, then he probably has to d(«] witb one of the 
acate spoci&c dineascs; its nature, however, cannot ordinarily bo 
diagnosed witb certainty till the choraotaristio rash appears. Still, 



w 



reununta or nvta. 



even Iwforo tlio advent ot tlie r&sh he m»f giro a Bhroird gaeat w 
to the nftture of the illness. Tlinii, tbo patient tnAj' lutve liecn in 
the oompMnj of mii infected peraon, or an ncnto conta^oas disaaaa. 
BMj proTftil. Sdorcorcr, ovon bvfore tli« ftppeanuaoe of ihu oha n ttJ 
ttfristio nab, tbo BjmptomB mftf sugg(«t on* of tho acuto spociSo 
diMMMW. Tbna, aoro-tbroat vtonld point to Bcftrk-t fuvcr; kotow 
baaka<;li«, bMtdadie, and ftoni'throat to STDal]-pos ; ooryia with oongli 
to tniAaloe. Sororo fcvnr, nshorecl in bj- a aeTure rigor, wilh 
aerere heaitache, aud paiu in the limbs, would sng^est typhus; 
n-liilri dall frontal hcatlncho with diarrhoMi would atronfclr point to 
tj'phoid feror. The mode of oiiEot of the foror, that is tho ntoro or 
loss rapidity wilh which tho tcmpi.-ralure monntM, and the mora or 
U«e olovation which it reaches, also aaeista tho diagnoaiai bat this 
poiiit will be mom dwolt on prcwntlj. Having tlicn in many caaea 
» strong ancpicion as to tho naturo of tho attack, be must wait for 
the nuUi to oonfirm or to L-ormct hia impretsion. If the second day 
paMW wilhoat the occnrrDnce of a nteh, the case in all probabili^ is 
not one of acarlet foror ; for the ia«h of tJiia disoaae appear* on the 
Kvcond <tay, being very rarely delayed longer, mare frtqnantJy. 
indeed, ocuurring before the Keoond day, sometimoa OTen in twelTO 
hoars. If (he third day lapses withont a taab, he is sot dealing 
witb a oaae of small-pox, for thia rash nsnally appoara pnnctnally on 
tho third day. In measles, it is commonly said that the rasli appears 
on tlui fourth day, bat in numy caaca this atatomont ia certainly 
erronoooe, for the rash often appears on tho first day of the fever, 
and I have aecn it even proccde tho fcv«r. In many inittancca, how. 
«TOT, though there is no fever, the patient eultera from corysaand 
oonf^ for three or four days ; but those symptoms may not oocar till 
tho rash appears on the very day the tempoTstnre rise*. This being 
so, it may, howovor, bo fairly taken that if the fourth day pusm 
witlioot a laab, the cane is not one of measles. It t]u> fifth day 
paaaea without a rash, the case is not typhns, for typhas rash appears 
ponctoally on thia day. The foregoii^disoaKabeingoxcIndcd. then' 
is thtm loft only typhoid fever, and one of the diioafiRM pro<lacing 
chronic fever ; luul the diagnoatiu ilifBcnlty wilt lie between typhoid 
fover and aiiute tukervuloaia, tho other diseases causing chronio fovor 
being. In many caaes, easily dotcoted. 

As tho ernplioD of typhoid thmoi^liout the attack maybeoilhcr 
altogether abamt or bo raanifeatod by only a very few spota, wlti«h 
may possibly escape dotedion, we roust in some cases diagnose tliia 
rtlaiann irrespeotira of tli« rash. The raah, however, appaars batweem 
tin aiglith and twelfth day. whioh makea the dta{n)Ml> oortnin. If 
wo ai« led to exclodo typhoid, thaD. as I have jaal said, wv liavo 
probablj to deal with a diJCMe which oaoMS obrooio tsTer. The 



TEUFSaATOBB OF FETSB. 



27 



I 



I 
I 



diagnoAS of ibe diBouo rcfomble to this bead will be tr«at«d of 
wlion we speak of clirooic fovcrs. 

I now giro aDOthcr inslAiioo of tbo diagnostic value of tcmpcriL- 
tore. A patient in middeEily Boixed vritli severe paiu on tbu side of 
the ehest. Tbe pain, shooting or stubbing to character, is intensified 
on oon^Bg or doop 1>reathing. This is the dtaiaotcrijitic pain of 
plcuriay and of pleurodynia ; — one nn inllnmmatory diiTi?aso, tho 
other a non-inflanunatory disease— which is it? A pbysicol exami- 
nation, it may be said, vril) at onoo discriiQinBto one from the other. 
lint sappose tbe doctor bus been aumiuoiiod tX the vciy onHut of tlio 
attkok, when ihe signs are undovelopod, tbe pain on moving the 
chast ia % BjrEnptojn common to both diMcnset; no doobt congh, 
preaent in pleurisj', maj be absent in pleDrodjnia ; bat pleorodjnia 
may occnr in a patient with Kligbt cutarrb of the bronchial tubes, 
and one would not ventaro to base his distinetiooi between tbeae 
dUcBsee, bimpljr on tho proacnou or absence of oongh. The ther* 
mometer alone aolree the difBcnltf. If the attack lb pleurisf, an 
inflamimitory disease, ihoru is fever (elevation of tcmpuratnre), 
whereaa tf tbe atiAck is plonrodynla, a no n-iuila tomato ry diBeasot 
fever is abecnt. 

In studying the temperature of fever, we most notice the mode of 
its run (iiutial period), itM character whilst at its height, nnd in a. 
lewer degtuti as of Idsa importauoe, its declination to tbe slftiidard of 
Iiealtlt. Tho character of tho rise often helps ua to form on opinion 
of the nature of the illness. In most febrile diseases tbe temperature 
rapidly ris^c, reaches its acme in twelve to twenty -four hoars. This 
rapid rise oocun in the fever of moHt inflammatiamt, and of typhua, 
aoarlet fever, measles, erysipelns, ^c. Whore tbe rise is sudden and 
npid, the onset of tho S}-in[>tonw in oqniilly Ktiddcn and aooentnated, 
and the rise in tho lemperaturo is (generally accompanied by ebiUa or 
rigon ; or, as in typbiui aitd pneumoniu, by a single severe rigor. 
Thb sndden and rapid ri«c, being common to so many atlaoka, ia of 
little diagnostio n*e beyond sen'ing to exclude those diMcoscs in which 
the invasion ia more gradual. 

On tbe other liond, in some disunsen, the tempemturo rises more 
grsdnolly and takes three or more days before it attains if nuLximom. 
This bappenii in most eases of tuberculosis and in almost all cases of 
tyiihuid foTor, and sometimes in rheumatism and pleurisy. This 
gradual riitu of lemponture is tlierofore suggestive of the invaaiOD 
of these discwes, and if there is no joint pain, tho ca«o is likely to 
prove either typhoid fever or tuborculosis, diseases which often closely 
simnhilc each other, so oloooly at the commencement im to baSIe the 
discrimination of tbe most experienced. As ia diseases with slow 
invasion of the fever, the doctor is nldon Banunoned till the tern- 



TKirpSUTUBE or FETES. 



pvnttaro has bocomo w«U developed, h» luu not often the opportuotiy 
of aaoenainiat; Itow it biw comport»d ibwlf at the boginning of llui 
nttiuil:. Hcnou, nt ihinetage, the temperatarc ui tuldom a serriiMahU 
gaido; the mode of tU nxa mtutt be efltimaled from the dow 
t|)iick oiuct of lh« njTnptomB. 

From the cuunui the tcmpornture ninit during the time tbo f 
ia at it* bcigbt> wo leani much more tliaa from tbu node of its 
ODMt. At thin jiuiotnre we mDNt regard the height of tlw thar- 
momet«r> the ■.■xtvnt of Lho daitv variatioiu, and the duration of the 
fovar. The height of tha tcmpeistare with ite dailj- VKriation» 
SMUnros the sorent^ of the atladc. Tbo greater the dailj ratiatioiu 
tlie mora faronmble the case. The high tempeiatnr^ as we hare 
aeeti, immediately and directly dopreasea all tho fanctiomi, and 
fortlivr indinctly lowers tUvm by prodoctDg degeneration of all tbo 
taimee; theae efbota of course Imiux luanifosted in proportaon to tbo 
b«igbt of tbo t«mpe<raltu«. Hence tlii'v aro far more toarked in 
oaaea when the temperataro all day ke«p«i high, than in oases when, 
dnring maay bonn, the fumiKiuture ia but little or nnt at all niaad 
above tbo limiU of health, A Kmperatnre of IW alwayi m»t*»» 
severe attack of any diaouio, mpocialty if tho diurnal TmriatMO is 
very alight. A tempumturu above 105* tbreatetiH oonaideraUo 
duBig&ti and from a temperature of 107* patientH, tinloas 
by oold bMhs, very seldom rocoviT. A temperature of 110* to ll'i*. 
unleoB it yields to the application of oold, in very qnkklf £atal. 

In the early days of tba clinical tbermoneter it was taught that in 
some diseaaea, as in typhoid, tJio temponitnro always K*cbed a 
chamclttrislio height, so that in a given ease, if by the fourth day 
the t«mp<!nitDn- fitilod to roach \03-b' Fah. tho cwte wan Mid bo b> 
not one of typhoid fever. Thin a!Molut« rule a more extended azpe- 
r(oncw baa shewn to bo erroneono. Typhoid and other fevers may 
ran their coarse witli any temperature above the normal standard. 
Some writers, indeed, go w> far as to maintain tkui typboiit fever 
ntay exist without any abnormal teuipernture, and if typhoid, ihey 
■ay, why not uther " fcvuni " ? Still it mn»t ho admitted that lUe 
tempontnre is a BerviovablD gnide in tho dieorimination of di<es»e> 
for sumplii, in the majority of vasos of typtiiu and typlioid fever, 
POM tea awl inftammBtionH, the temperature resebea I'M', and oer- 
tainly if the li>m|K!mtDrc never csceods 101*, then probably the case 
is not typhoid, ty|>liui, scarlet fever, meaalea, nor any importaat 
aoole inllainmation. SomeUinoa the tbetiBOmeter grc*lly nsNista as 
in dtHriiniuaiitig nioasles and scarlet fever from German uuaslea 
(rOtbelu). ThuR, in Oorraan mensJcs, the patient often ootnplaina of 
•ore throat, and sowelinws itH nsh ijt ao like the ranh uf iimrlol forer, 
and KHuetiraoa so like tho rash of mcoalesi that simply by the aspect 



TEKFESATQBX OF ttYKK. 



29 



It is ilifBcnIt or impossible to dittingni^ tbem. In thin dileraina Uie 
t«iiipemtnre. tbongk not na absolnto proof, ttfforda strong preeiimp> 
tive svidonoe -, thus in Gcmuin meaitlca the temper«tnrc gcnondlj ia 
soarody or v^rr xlightly niisod, not higher than 100" or 101®, -whiUt 
in iDMelM ftni) in scarlet fover, in the frreat majority of cns(«, ihe 
tonperatnrc mnii higbc-r than tbis. 

Tho oonrse of the tempentan vhen at ita hoigbt in<)i(?nt«)i, ns I 
li«T6 mid, not only th<^ Mvttrity of thn nltark, lint also helps uh like- 
wise to distlnj^iah ita dnralioD. If the lempcmtnro i* high, and 
the dtuly Tarwtioos oro slight or non-oxistent. a serere nttauk 
thrcattn*. sura to persist long«r than a case vrilh oonnderablo daily 
falls in Iho temperntnre. The information tbusobtained ia especially 
instmcliTc in typhoid fuver, for if during the second wmk thor» are 
daily groat Tariatiom^ wo have reason to hope that the disease may 
termtnah!, possibly on the fifteenth, though more probably on the 
twentieth day : hot if do ring the second week the daily Tariationi 
are bnt olight, then tJio fever will prolmbly lost twenty-flvt' or thirlv 
days. 

WbOD th« temperature lias rcimnined purs intently high, the 
oeonrrenoe of morning falls shows the beginning of tbo decline of 
the disMuo. 

TAe duratinn "/ (Atr/poer helps ns to detect tbo nntnre of the dis- 
mse ; and indM^l in obscure oases it often greatly aids the ding^sis. 
Ia most inflammations, in scarlet fever, in tnossles, the fever nannlly 
passes away by the Bflh or tenth day, and in typhns on the four- 
teenth or fifteenth day. If the fever persists beyond tbis time it is 
fair to eonclnde that wo have not to deal with one of these diseases ; 
hot as, in the majority of instanoes, thoy are easily diagnosed early 
in their c«nn«. it is evident that in sncfa cases the duration of Ihe 
fc^-er ia of little practical nra ; bnt by enabling on to discriminate 
betweet) typhoid and tnlieronlosis and between the disonsea causing 
ohronio fevor, the duration of the fever docs givonsvcry trustworthy 
and important evidence. 

In some oases of typhoid fever, tlie symptoms are not «n6iciently 
marked to enable the doctoir to decido whether tbo case is one of 
typhoid fever, tnbercnlo^ip", or phtbisi*. If the fever goes on beyond 
thirty days then jiroiMibly tbo patient snfFers from consumption ; and 
each additional day of fever strengthens this conclusion. In most 
eaac>s of phthisis, before the thirtieth day, the Innga or otlier organs 
will, it if true, generally manifest the nature of Iho illness ; bnt not 
anfreqnciitly the fever of consumption may persist thirty days or 
more withont tha concsrronoo of any cbaraotcristic physical signs or 
Bj-TOptoma of ita oxistenoe. IVlien I come to speak of chronio forer 
I shall point est with more particniarity that sometimes tho 



thennometer will cnnblo ob to det«ct consunptioc earlier Ui«a bj ibe 
«omfaiDC<l aid of tlie ajrm)ittiiutt iind the ]>byaioal signs. 

Ad7 ntcldtD and coiuideTabl» tampomtiirD Tari^tion (•ein-mll/ 
forebodes Bome oomplintion; and a sadden and coiuidt-niblu rinc, 
alway*. A audd«n and oonsiderablo fall may, of course, iodical« 
lli« n&taml termination uf tb« attaok, for in manj diMMwoa. tb« 
tonperatnre falls verj rapidly ; in pn«omoDia notAblj', it id not 
nocornmon for tJio torn pcrat are in twelve luiim to Ralwido from lOii" 
to tbc Dormol standard. 

A sudden and marked ritm in thu conrM nf a dimuo foretells tlM 
onset of soma inflammatory ooraplicalion. On tho otber band, it is 
importiint to boar in mind tliat an inSammatory onmt, interposed in 
tlie eounte of a febrile disease, may not boigliteu the oxiitting 
temperature \ bene* the fact of tbo temparatare ronning the ordinary 
oonrM pertaining to the original attoolc, does not preclude tko 
necessity for close watching, Int an inBammatory complication sbontd 
BopcrveDO. Thus, an attack of pneumonia or of pteuritiy may loave 
tho tempemtare of jire-i'iisting fovnr nnaffoctcd. It is important to 
recollect that, as a rule, the onset of pericarditis in acute rbeumatiua 
does not inoroave the ferer. This is bardly to be wondered at, se«inf; 
that wboa a finab joint beoomes implicatod the t«mpcnturo does not 
alter, and Infianmation of the pL-ricardinm may be re^farded as 
aitaJogona to inflammation of a joint. 

A sndden and ooncideraUe fall, if not doo to the natural termina- 
tion of the illncas, nMiaos Hnddra ooltnpw. It is oftonest met wi(b in 
typhoid fever, and it means bipmorrhage into the boweb, or parfot*- 
tion of tho intestine. It mmrt, however, bo rvoollccted that each 
wook in lyplwid fever a great utoming fall often occurs. A tidl 
equal to that, doe to boamcirrhage or perforation, may occur at any 
time, but the fall with llicse aocidenia is more persistent, and is 
always aeoompaniod by the symptoms of collapse. A sadden grtAt 
(all with ooUapao and withont tenderaess of the abdomen, is almtys 
vnry ominous of hainMm-lutge into tbo bowel. This hanoorrhsf^i, 
though oonsidemblo, may yel be retained for some honrs in iho 
intent i DOS. 



CHKONIC PEVEB. 

T> sonw disensM f«<rcr mar pereiot lor wiwka or moslbs. and by its 
Tory dnratinn help (lin dinKiioHiii. Il is true that in mosi uasus, 
whilst the fever has laaled only a short time, perhap only a few 
days, the olbsr aympUmu iweal llin nature of tho disease ; bat nob 



CBBOSIO rtvtit. 



31 



I 



nnfrcqucntljr the nature of tha malady remmna for » ]oag tim« 
obflCDre, ftnd then iho ponistcnco ot tb« fovcF is an important help 
to the diagnoaia. 

Between acnto toid chronic fever there is no Kharp line of doraarca- 
tion. Certain acute dUeaam, for iuirtauce, typhoid feverand [ileurisy, 
majeacb run more than thirty days; whiUU on thu olhor hand, 
fobrilu diwMMUi. like deep-sealed ahjoeasei and eonsBmption, which 
oft«n continne several weeks or monlhR, or eren longer, maj mn ft 
abort coano of on\y a fortnight or three wogIcb. 

Stnoe most ncuto illni.'MWii, oven typhoid fever and pleurisy, which 
iwnist longer than others, oomo to an end, in the gt6a.i majority of 
cases, before the thirtieth day, wc may take that as the limit of 
acnto fever. 

Chronic fever oocurs in phthUin, abMcees, eyphilia, ague, rben- 
matiam, in most coam of loncocythtemia, lyniphadinosia, and per- 
nicions aniemia. 

AainaoBt(!di]Kaaei,>oinaoi)tcand suhauutd phtbinis, the tempinn- 
tore is a meaeore of the activity of tho attack, of the amount of 
tubcrcnIicatioB and of catarrhal pneumonia, In other words, there 
occnrs a daily elevation of tcmperntnrc of tho body, in all caaes in 
which a deposition of tubercle is taking place in any of its oi^aos, 
or in whioh catarrhal pnoutnonin, is pro^^Being in the lungs. Thia 
etcvatioa is an index of the activity of the diseoae ; tlie fluetantions 
of temperature indicating cerrusjiondiDg fluctuatioQS in the mte of 
the disease. 

One exception, however, I mnat mention to the above gsoffsl rnle. 
In tubercular meningitis, it is by no mcnna uiicomnui^ Hioiigb it 
cai^nly ia not tho rule for the temjientnro to Kmain Dormal 
throngiiout the oonrso of the attack; or at all eventa during most of 
ita biter stagu. In noma caaea, for a abort period, the tempemtnre is 
•lightly eJevated, and then becomes natural, or faltii oven below the 
BomuU point. Id by far the greater uumbor of iustanoe* tho t«m- 
porataM ia elevated, Rometimo*, indeed, monnttng to 105* to 108* 
Pah. 

Tlwro *ra 1*0 ffuiblo ciiJuiitlaa* of IhU phnnonenoi], eiUiw or bot)i ot ithieh are 
tcMbl*. W* tuf tappoie Uikl in otrulo ptrti ot tba natroua ijiUtn, m jet naknoirn, 
A* dtpMltbo of luberelo iii«r pntcnt s tiw of UrapnntDrs ; or thu dnrini lbs tubot- 
eaUr dvpwilion, » Hm of tampenture oocumd before Umclj oWmtiao* inn nailo, 
ud tkal ftlUrvuiU, no Inrlher d*i>otiiton l««k pitee ; tbe pjitioDt <I^nj[ fram tbe cllwl 
«f lb* labareU depMiteil bcfoi* tbe lenpentote na noud. Tbe formor !■ probablj th« 
tni* iaMp(*t>ties ; for in uma «««, obMrted trom noailr thu comiDrBCMDeiii, tbo 
iMBDcntar* in lbs rtcinm ninunoil Domal Ibreughoutihs itiaok. Id ibne non-hbrile 
nam ot Moio aullat; tuUieBlosii, eoDcralljr but little taberole itili, I boliere, be fouoil 
be}ci6<] the briin and iti membiuu. 

It liiia been assertod that, dortng acate miliary tubercnloitis of tbe 



32 



CB80S1C rsTsa. 



tangs, the tempemtare, in rare iostftnoce, maj renuuD noniuil. With 
regard to thin KtBtemcDt, I boliuvo Uxt the d«pMit of inbercle torn 
gone OD bj verj slight and soaroelj appreciAbl« inoroxwDtd ; nr ho* 
boooiDo obnolcsciMit ut the time tlie tAnperfttare iras finit Inkon. eo 
tliAt the foTcr stage wu overlooked. It mast be adimlted that, in 
some Ytirf vkronio cMWS, either of tDbcrcnliuition or of catarrhal 
pnesmonia, the diRcnae adTaitL-eii too elowl;, and tlie deposit, at naj 
on« time, i» too slight to bo adoqnate to eWate the temperature 
Qidem lo a very finiall extent. 

Tfatu, «o mrct with cases in which, some time before death, th» 
iomperatnro iraK alwaj's nataral, yet the po«t- mortem examtnatioa 
rareaU moch fibroid dep>neTation from old standing tnberde or 
catarrtial pnoumonia ; and adjacent to the fibroid portionit, in llie 
otherwise heolthj Inng tiaanc, wo see a few recent miliary taberclce 
MBJjooontod.or a few small patches of ncent catarrhal pneamosU. 
Indeed, in tbeae diacaaes, we meet with erei^ deforce of aetivitj' to 
which the tempcnitaiv oorrcDpondit. In Bomc cases the dineaoi 
adranc«-i> so alowly that the temperature is Boarraly raised, and we 
■liOnM naturallj orpcct so verj sliffht an amount of morbid Mtioo 
wontd be ioNnlBcient to raixo the temperntnre apprectablj. Whtrs 
there ia uo eloration of the temperature, we may oonolmlo that the 
progroM of the dtaeaso is almost inaignificont ; although Uio patimt 
IN exposed to the larking danger that, from some alight caaee, this 
oomparatirely harmloM oonditiaa may ho aggmvatod into a wmon 
and dangerous attack. 

The apparent exceptions to this atatemeot can, I think, be oxplalned 
in tJiis way : — 

With phthiais, as with other oanao« of ehronic fovor whore tba 
diseaae goes on but slowly, it mnst bo borne in mind that the fever 
may last only a few honra in the day, sometimes not mon> than thive 
or four, Bometimos only is the middle of the day, so that a moroing 
ami oronJng obsorration may miui tlie fevn-, and may load to tho 
onoDeoDs coiK^Insion that tbo patient was feyer<frec. 

Anothur source of error arises fmm tlio mtxlo of taking the Um- 
paratnre. Phthisical patients are often very thin, and henoe ihebalb 
of the thermontoter. when placed in the axilla, iitstcad of boby 
embraced all ronnd by the tissues, lies half cxjiosed in a hollow 
cavity, and never ntquircs tlio ti'mpeiatitn' of the body. This 
•oniro of error in, moreorer, often coupled with another. When 
tlie patient is |Mrhapa dressed, or has had his arma out of bod, and 
his axilla hna boconM oookHl, it wontd tako half an hour or an hour 
lieforo the skin of the «Kposed [arts wnnld rocovor iUi iMt hnnt so •• 
to nark the t«m|vralun' of thn body. Over and over again, Ja 
hospital pcaotjce, t hare boon told that the lemporatnro was normal. 



I 
I 

1 
1 



canoNio rsTSit. 



33 




T 
be 



^or pron bolow norm»l, bnt on lakiDi; Uio tomperaturd nnUur tUo 
tongnfi, or in tho rctituin. hava ((mntl the jiaticnt taflcring from 
sovonk] ii^gnw of fe^-«r. 

In aomo cwo*, it mtiMt bo admitted, thorc Appi^an; to bo a dispro. 

portioti between the prograsi of tho dim-aso nud the tempcmtura. 

[This diaproportion oconni, T bolieve, only in ciu^fi of long iitnndiii^, 

Md wbnt the discaa? bas Wt«d n i.-i>nHidi<»l)Ie time, ]ierlin]Ki It 

Inoea leesDlcmtion lIiAnitt Grst,lbe patient booomiuQ: ncciietonicd 

[to the difteose, and, ad in tho caw of ntodicinoH, it pioduci-H luxu con- 

Btitniional effect. An tho raealt of my esperienco, I am inclined to 

' think that the a&rae amount of iIimumo in middltf-agcd and iu elderly 

pvople prodncoai 1um> forcr than in the yonnff, and that Uss forer is 

prod&ued towaida t1i« end of the disoiuo, when the patient'ii po^irc-i'M 

I greatly dcpn-sscd. 

The tenpcrature tit a ninn' nocnrato indication of tho aotivity of 

nborcnloaia or of oalarrhal pneumonia, tliaii either the phyBical 

•ignit or tho iiymptoRu. Thus, only a consideniblo iiiirronito in tfao 

amonnt n{ disease can bo detected by {iliyninal si^s ; and in (lis. 

seminatcd tnbiTeulngis, where tho granulations nre pretty equally 

■e«tt«red thmufflmut Ihe Innifit, and, indeed, often IbrouKb most of 

tho organs of the loidy, there may bo entire ahsoDce of physical 

signa. Thus, it h apiMirent that the phviiioal Kffna, even in very 

acnte cases, only give ug ovidrnro of the onntinnance of tho disoM9 

titttr tiu! lapac of & cuutiidcrabte interval : wUiIal it haci been iihovn 

that in almoBt all nuscii, there is an elevation of temperature during 

the depofiilion of inlietcle or the fontinuacoo of catarrhal j)ui'Unionia, 

and Ibal thiii olrvniinn bcint propnrtionnto to the activity of tho 

disotwo, tho lliermnmuter will, uuerrin^ly at any time, point nut 

contiunanoo nnd tho amount of di«mso, except, indeed, in thoso very 

chronic nuuM «'hcr« the nuiount of tnlierculization tn- of oatarrhal 

pnoumomii is nlight ond almost inHigiiilicant, When K is thus home 

in mind that only conxiderable depD»it« in the lunga can be detected 

Hliy phyitical signs, while evon a smiill amount will raico tho tcm- 

Hpointare even conkideraMy for aome time, it bi'comea erident that tho 

Btharmomotcr will ^veafur better estimate of the amonnt of mischief 

Hjlhnn the phyHical fti^rns. Moreover, after the ceanation of tnber. 

^Beulodis or catArrlial pnuomonia, consolidation from the fibroid lung 

nvtnina, and from tho physical tiiftas it is iniposcilile to toll the 

condition of sach a Inng, to tell whether disease is progressing or 

noli the temjarratni-c will nnicwcr th<! qm-stinn for a». If tho 

tenperature is natund nt nil periods of the day, we may safely 

conclnde aftvr a few days that aoti^ti diKtmiu has very nearly or 

^nntiroly ceased. 

^1 It must bo reoollDcted that tha fever is a iDBBSDrs of tlie inereai* 
H 



nf tbe tuberonlizatiun, or of tUe caton-lial pncunwntfti not ct tbn 
danufce slr«iuly tlono. I'hiu tbi» dimaso may obmo to extond and 
thd tempeiature become normal ; but Uio exU-iiaire L-ouMlidntion of 
tti« lung may boiiin, and coiitinno to Kiftva and lead to cuvilicit. 
HouM, beonnse 1<b« f«rer ooaoea, luid 1h« formation o( (resli tubercle 
of CAtarrbB] pncamani* ocaae*, wa miut not oonclndo tli*t tbc ]«itioiit 
jft free froiti daui^r, for tlie soft«aing and BappuntUon maj- lend to 
fatal oxItnoKtioa. 

OUMirvatioQ of the tem|M!raturo often Karon lu from error, and 
«nablea ns to form n corrtot jndg:nient of ttuj true oondittoo of tbe 
patient. A patient irrilJi ouljr a inod<n«to ninonnt of fever, §my 
Vyt to 103^, liiitiug onl; a part of the day, has been loaing vrviglit 
and growing weaker. She gom to tJio connti7, Iter appetite and 
aMiintilutivo powers incivase. she Rrowti much henvU-r and atron|{er, 
and rogniDM taatih of her lost oolonr. On a phjrsiCBl oxaniination of 
tko chrxt. we detect do inorosse iu tbe phjtical aigna, but durini; tbe 
wholv time the temperature biu rinm to iu aoooatoDMid Itcight, \<Ji' 
to 103*, ahowing that tho dtaease still progresMs, but that lb« 
unproved appetite boa more than obviatod tliu woate from tho foTOTt 
]b other words, nntritjon is in oxoeeii of wnatc. 

On tbo other hand, we uuMlbooarvfol not to ptij Urn mnoh baadto 
the tenipcrutHrv, nor to build oar pro^oma entirely on it. For it 
ott«n happuaa that tlicre » n msrkod <IUproportioD b<itwe«n the 
f[nin«l Ryio|)toBUi and tbc degree u( tuW realisation, or the rata of 
formation of tbc pnidiictM of catarrhal ptieumonio. A potienti witli 
very nIow iiroifreuive pbtktsis and modorato fever, Msootatfld witb 
tlif Very slight phyaioal Htgna which develop tlowly, Ina a fUggiatC 
apprtito, and he iiniolcly wastes; or somptimea a good appotitw, bat 
aasiinilatioii U at fault, and to, in spite of plenty of uouriahinant, h« 
prof^mwivcily grow* thinner and ihinnar. Tlioroforo, wq miutt ngonl 
not only the tenparatun aa a Ri(«snre of tho projrresM of tho tnlwr. 
oulixatloti nml the inroad of catarrhal poonmonia, bat must likoiriM 
Utkn into roiuiilcration the |xtticnl's appetite and weight, tho oconr- 
tvxwa of com plica I tun, aa diarrlKcn from ulcentUon of the inioatinoa, 
the pr«wi»c» of albamen in tho urine (rum fatty ktdner, and whathar 
Ibominoid detfenerution boa implicated the liver, spleim, or kidaDy& 

■rlui U At r«*«f •loa Ib »tvi» miliary labtnratnl* t 1^ ib« fnmiiiha of tt« 
iBlMi«l», a U Uh wUnlid pominoah wlil'b MM«(aalN k Tbo uavM b dlatellr 
W4naIII«|WtaMa AuUotUn uc ■»* rnU; nil aKrawJ lliat ia lotxitakifa tbwo la 
(t*w. l^iM Maialal ^ barcrcr, that IW (ornaUta af lalimta itm aM mhw tk» law, 
liNl Ihal III* bw I* da* la lL« niliiciid<«t powtaaaK anil lo At aajipiiialkn ttom 
•anralai laWrd^ AMsadag Ikl* vl*v la !>• camti, ibta u Uw iMinuaMla b do* I*. 
aarf |Wtt|NniMiala 1*, tk* ■MWnl at Ui« i1i>ria>lliM of labmla, it k ab>tMi lUt tha 
hwr talnn HopetUMMU lo At <*unbtl pwUBonia u tIi««lK imiMtlWUti U tka 
aaMoKtal laUitl* IrawwL 



I 



CHROIIIC FET£B. 



35 



Dr. Tbt<>tDrc Williuni iMiibn ilint * mfaiKiTaul tcinpentaK BctompiLiiici tlis dcpcal- 
tlon ot lubtrcl*, tail llul in nmv imtaiiMi « lUfa «l ilepKMBil Icmpeialurr t>tiic«]ca 
(]>• Uvrf •(•(«. Such caata I hurv nctcr bmh. 



^H Fibroid ])bllii«i» reouunii now to bo conHiderod. CalArrVio] pnon- 

^■uciata. or labercle, behaving aa an irritaut, indncca inctvaao of the 

^BOtinoctivo ti<sti« with fonuation of lihroid hnnds. n hich caaeo tlio 

^Pnng to become tongb and fibrous. TbiK onnditiim of lacK uftvn 

GO-oxista with Ml crttiision of the mlnrrhnl pnenraonin, or proerowivo 

formation of tubercle, WTien (Iw further iirojfrww of tb^e two 

tiisoamB i* Ktarcd tlii« filnxitd cnndition is left. Tbis U th« most 

eommoncftUM of a Gbi-oiil lun^'. Imt it way ori^inat« in a differenC 

way. Tlie ivmpcmtaro in fibroid phtbisia varied. In oome onsee it 

i* quite mitural, or if tho bmltb Ik mtich doprpKKcd, it 'm uvon bclou' 

ijnormal. lu tboso CMce whi^h ga on to cnre it is natural. The walls 

ibo cavities boeone dn-, rbonobaa and cxpcKlomtion coanci, tbe 

ivttios slowly contract, and tho pntiont rocovcn^ health and strength ; 

it tbit indtimtion, very obviou-n on a physii-al uxaiuinatiitn, iitill 

io& Now in a case like this, the temporatnro often bocomw of 

bo grc*t«iit importanci!. A pntiiMit present* htinself tvith a liintory 

R prorious attack of phthisis. We find marked evidences of 

nsolidation nf tbe apicvM of the liin^. The patient's health is 

\, bis ap)ietite and diRestion vigorous. Aro these phjsioal signs 

kimpty due to his prevtonx illness, or is tbo iihtbisis progroasin^? 

If bia tem]>emturu remains for several days quite aormnl, wo may 

onclndc cither that thoro i» no progrosKive tnberenliiation nor 

ttarrhal pneumonia, or tliat it ia Tery nnall in amonnt ; for, as we 

ftU shortly r<^, tliere may be probably a slight Mnonnt of catarrhal 

eamomia, without a rise of temperatnre. 

In other c»m» of fibroid pbthiniK, even when tfae' lonsatieD of 
ibcrclu ba« ceMteil, we may lutve a sligbt daily litt (a thfr Imi- 
teraluro to 100* or «Ton lOL*, dn« to the snppnralion in tbe caviticd. 
Tbis Kuppnratiou can, of conrce, raiiie tbe temperature jiiet like 
uppnrstioa in an open dieclinrgin^ psoas, or other disohar^ag 
'abffCOBH. 

Th* persistence of a alight umonnt of fever does not, therefore. 

arlasively prove tho oontinnnnco of tliu tubcrculixation of catarrhal 

neamonin. Nor, on the otltixr band. I think, can we possibly nay 

nt whilst tbo tamponturo it normal tbo luberralixation and 

ttan-bal pneumonia may not bo in a veT}' slow defiree extend- 

aff. (.'Unical itxpttrimiii hIuiws na that a very smalt fktnnAtion of 

iborelo or of catarrhal pnenmonia may occur without a rise of 

ii|iBTBlure. 

Wo very oflun moel with mixed oaaes, wbcte tbo upper part of tho 
inff baa beoome fibroid, wliUst uctivo discuee goes on in tbe lower 

d2 



36 



CBBOKtO nXKB. 



part. In cAa^R lilco tbia tbe toraperatnre in nuticd in proportioti ta 
the activitj of tlie ncntc (tiwMC!. If tbo disoaw progrococa stowlf, 
and TWSM tho UtmperatQre to oqIt 100^ to 101° Pah., it iit dilBcolt to 
deterroine whether the fbror indicnUv nn oxt«tistan of the tuber- 
calixfttion, or of cntairhal pneamonift, or ia dne to tiuiiptirAtion in tbd 
cavili«a. 

As in ncntc phthiHiit, no in clironic!, vi'iih Bbroid inn^, vre ninst bo 
OKrefnl not to paf boI« regard to the tpmpor»ttirct, Thna the forouv* 
tion of tnb«rcU) or the exieation of vatarrlial pneamnniA cciuwa, and 
the temperature becomos normnl ; but boforo this coniM to pass lh« 
hoolth miyf iMxnno dAmiLgcd beyond reeorerT. or the kidn^ naj 
beoomeMrionaly implicated, or tbroagh lock of appotit« and iligM- 
tivD power tho patient maj' vraate mway and die; or tJio nncrrlaia 
weuthci incidental to Ihia country may irritato the cavities and kt«p 
np continnoDS anppn ration, wbiuh draina away, vxbatiiitK tho Ktmtgtb, 
and duRtroya the patient by prodacing wide-sprvad albuuinuid de- 
gciMt ration. 

Tbcrrofore, in a cMo of fevor-fi-ee phthiaia, wo mu»t lake into 
ooiuiidemtion the (^neral condition an well an tho tomperatnre. When 
appetite, tligevtion, and aaainiilittion aro ffood, tbcn Ihu patient 
quickly retina atreDglh and honllh. Thorcforv, iu fonninK an 
opiniiin of a naae, wo ibuH rei^rd the tempetature, tho appetilv, 
and the weight. 

The t«mperatur(; in phtbims aftonlit im atill further gutdanco. A 
|>atieut throws np a largo quantity of blood from tho Inogs, und Um 
gravfl (jueotions nriiv, — ia the lucmutTltn^ due to tho congestion 
which aocompantea acnte phthiaia? or ia it independent of pbthiata ? 
— will tho ha'tnorrhngo in iln tnm excite phlhiaia ? If tho teiB> 
penturo ia normal wo may at odoo exclude acntv phthiats ; aii<l if the 
lenipvmtnrc reniaina norma] we conclude that the hainvoptygu hM 
not excited catarrhal pneumonia. Again, a jiationt liJiviu;; eocoT^^H 
fmm a previous utliurk of phtbittiti, which has left WL-jl-inaiifll 
phjeical B^gna. spiU a little blood. Doe* thia Hhonv lliat ha ia agaili 
tlto Nuhjoct of proirrcMtvo phtlii«i«,or ia tho bleeding duo to nlona- 
tion of tho watia of an old cnrity ? ITero the tenipcnilure, if 
Bormal, nn<l conliiming noniiiil, enabloe ns (o conclude tliat the 
luDDwptyM)! doea not dt-pciul oa auother attai^k of phthuiia. 

The thonuomdor in many caaoa i« of atill morv aignal aerrio* >a 
giving euriy and aignilknnl warning. Uy its aid we can otUiu 
dtagnoae Inbc'rcntoxia or onrtnrrbal piu'omiinia, before we can detect 
any physical signs, and at a jicriod when ayuptomii thcmM>lrM an 
inanflki'iit to jnstiTy a grave di<i(tno*is. A patient aalTora from 
olironio tever. VVhal is the caose of it P So far as wo at pmont 
know ofaro&ie teror ocean only in tnberoQlosia, oatarrbal paeuBOBki 



CHBOmC TKTBB. S7 

large abscesses, rhemnatisin, ague, occasionally in sj-phiUs, in some 
cases of leacocjthtemia, in lymphadenoma, and in pemicioas anemia. 
The diagnosis of agne and rhenmatiBm is rarely difficult, the chamc- 
teristic symptoms in most cases rendering their identification qnite 
easy. Large saperficial abscesses present no difficulty, but it may not 
be BO easy to detect daep-seated abscesses ; and in some cases the 
diagnosis is for a considerable time impossible. As a rule, however, 
they give more or less pain, often to a considerable degree, in the 
neighbonrhood of the abscess or over the spine ; moreover, a tnmonr 
ifi generally detectable after the fever, if at all high, has lasted a few 
weeks. Local symptoms, too, as pain on movement, stiffoess, lame- 
ness, &c., will, in most cases, point ont the nature of the disease. 
Sometimes, however, deep-seat«d abdominal abscesses ma a much 
more chronic course, the temperatare then assuming the character bo 
common in fibroid Inng; thus the temperature rises 101°, even 
perhaps to 102", and daily mounts to this height for a few days, then 
becomes natural for a variable time, but some cause, as over- exercise, 
once more excites the fever, and the temperature ^ain stands high 
for a week, a fortnight, or longer. It is often very difficult to deter- 
mine the nature of the disease, and to ezelude tubercle or catarrhal 
pneumonia. True, there are no pulmonary physical signs, Imt 
these may be absent in phthisis, whOe the local symptoms may be too 
few to justify the diagnosis of alMce^. Having but a limited experi- 
ence of deep'Seated subacute abscesses I would wish the following 
remarks to be accepted with caotion. In general there is pain in the 
abdomen, not constant, bnt brought on by slight walking ; sometimes 
there are marked dyspeptic symptoms, amongst which flatulence 
predominates. A slight daily rise of temperature continued for a 
considerable time, or running the irregular conrse just described, if 
accompanied by deep pain and tenderness in the abdomen, the lungs 
being free from evidences of disease, will, I am inclined to believe, 
justify the suspicion of a deep-seated subacute abscess. These rules 
at all events have enabled me to diagnose doubtful abscesses, when, 
nnaided by the thermometer, their detection seemed impossible. I 
lean to the belief that, with these abdominal abscesses, the fever-free 
periods not nnnsaally persist longer than in subacute phthisis ; more- 
over, the rise can sometimes be traced distinctly and repeatedly to 
exercise, a bout of fever, accompanied by an increase in the other 
symptoms, occurring after each undue exertion. If an abdominal 
tumour is detectable by the hand, or if there are evidences of diseased 
spine, then, of course, the diagnosis is far more easy. 

Again, a large dischat^ing sore, or a discharging psoas, or iliao 
abscess, frequently produces a course of fever like that described 
Buder subacute and chronio phthisis. In some caaes there is a alight 



CmtOKIO rKTER. 



^mily elovation lasting for ihobUia to othur cwtM tlto abnnnnal 1<;ri* 
p«rMtira wotiBnce fur only « few daj's, or laats ddo or two weuka, and 
ihm for It Hhort time {alU ngikin, nnit lliii) iiItvniatUiD Buy bo rapeated 
for * oonsidcrabto tim«. Hcru Iha (liaj^iioais ts ea^i for Ibetv is a, 
dinebargiag aoro with atwonoo of pcctonJ phyMCAi sign* or symplontB. 
In CSMW of constHnliounl Mypliilin with oluniiio ferur.tlie diagnoais 
in muiy cnnvn in inoiv diHicult, and, nnfortnnately, liltl« of thb 
snbjeci is Icdowd at pn-sent. Xhu tciuperatura mny be high, rising 
to 103° and lot' Fall, daily; (he mcrDing remissions are usually 
great, the tempemtnra often falling to 98°. In thcao nspocta 
sypliilltiti fwer corresponds to modoratoly tevero CMire of pht]iisi<«l 
fever, but generally di»tiiict and ensHy n.-co^'nixalilL' cunntitatiooal 
■ymptoiDs sot in cN>i>ciim)nt1y with tli« fever. Tba disease may 
sssano the rheaiDatio form ; and tboa the diagnostio difficol^ will 
bOt not between pbUiisis and ftyphilts, bot between simple acute 
rtununatiMin and syphilis. In mnuo cases tbu diaguows haa seemed 
impossible nnlil, on tbe ndmiiiictnttion of iodide of potassiiun. tbe 
tcmporatan' i>t once became nonnal. or declined grudnally, ratobiag 
the tem|>ci»tDru of bnltb in one or two weeks. Very lat^ doses 
nuiy be required. 

Awnming the rxrlnaioii of Iho foregoing canses of ferer, IIm 
<]aaet)on arises— Efow long must tho dcralion of tvmporatnre penist 
boforu no can with probikbility atiiipvct (nborvulotua or cntarrlial 
pneumonia, in caae^ free from physical aigns or cluinint«ristic 
Rymptoms, aa, for instance, hatmoptyiis ? From t«n to tweaiy days, 
1 think, each day facilitntin^f and strengthening tfaa diagnosis. In 
tlio first fow <layK tho iliagndds is well-nigh impoadble, Imt each 
racoessive day aorrm to oiclndc sonrcea of error. Thus, on tbe 
Bcoond day, if tbe rtso ia dnc to scarlet fe^-vr, ita obataoterititic! tosh 
ongfat to appear; if dno to stnall-pox, tbe rash sbonid appcer on Ibn 
Uiirdday; if in moa«k«,abonttb« fonrtli ; and in ty^ihiu.nti tliu filth 
day. Ileforo tha time, if tbe riae is due to acute inftutiimation of 
tbn biuin, lungs, kidney*. Ac, chanicteristic symptoms and phyural 
aigiia will bare set in. In moslcnMM of ly]>boid fever tbn roso apota 
will appear between tho eighth and tenth day ; and at this statin we 
may exolnde most camoh of simplo infiammnlion, wbirli oanally 
dodiao bofote the Itmth day, when tbe fever ceases. TIiuh, on tbe 
tenth day, or Ibereabouta. aasnining, aa we have naid, tbe vxolusioo 
of tbe otber eause* of obranic fcrcr, tho diagnostA lies Iwtvrrou lubur- 
cnldala and typhoid favor. In Uie onrly Stages the discriininnlion of 
one from tbe other ia difficult, an*! may indeod lio iiuposmblc. Uaeb 
begins gradually, and is not usually tulMnvd in with cbilb, ooD- 
vnblons, or rigun; nor barn we ordiunrily to assist our jndgmenl, 
diMtwrtave aymptocas, like tbe back and liendodio of unall-pox, tbo 



OHBAXIC rETER. 



39 



^ »oro-thro«l of tcnrlol fiercr, the coryeii nnd congh in moulM, before 
the advent of the chAracteristic rasli«H. It ia tme tbftt in the 

tbvginning at mitny autx of typhoid f«vor, liofnro thp nppeanHioe of 
thenali, thore iBdiarrboMUDd heudaohe; huttli<m};li th«aosjm]>toina 
point strongly to typJioid fovrr, yet tlipy may bo prosont tA the com- 
menooiaGnt of ncnte tuborouloHis or c«tni-rlial pnuumonia. itoreovor, 
diftrriicM nad oven hratUcho niAy bo absent in lyplioid fovcr. Bnt 
by tlie tenth or tho flft«entl) Any ihn diagnosiji in uioHt ciuu:a l)L<(;i:ini<-H 

Iwwy; still it mnst bo admitted tba,t now and then wo enranntor 
perploxiDfp cases of typlioid forcr, vrbioU rendur tho tUugnuiiii 
betweon it and tnlmx^nloeis or ctttiin'bal pnoumonia doubtfnl for a 
innuh lonHCi* tiutu; the tbirtiotfa day onoo pamed, fbonld tbo dixtNuio 
have remained to long undetennined, it is in all pi-obability not 

» typhoid fever, for thiK oMtinlly ccuuck either I w faro or ut tliU tlmo. 
Yot it iv well Icnon'u that typhoid ferer occasionally lasts eix weoks, 
or loDgor. In children, the dini^ROBiH hcttwocn typhoid (ever and 
acate miliary tuberoaloRis in often extremely JiSlcnlt, the symptoms 
of typhoid hvia^ in some cases so ilUdolined thai many gt>wl nlmorvers 

ItvfuMi to consider tlivm to denote typhoid fever, luid call them aimplo 
continued foror of ehildron. Uany of tbcso casce are prnUiUy 
.■onto lubcrculoniK, tho depoKit (xnKing. and the tubercles becomiuK 
obsolescent and harmless. Uf cenrse the diagnosis is diflicult only 
irhvn, in ftcnto miliary tnbercnloiiiK and ratarrhul pneumonia, there 
^iire neitJier physiotl si^a nor charactcriKtit; symptoms. 
^M A^in, after typhoid fcrcr, a ptiried o( fever may Fct in luxtin)! six 
^B'weeka or two months, the tempernture bocomin); almost natural, then 
^ft^kily rising higher and higher In 101 ~. 1U2", even 103°, and after 
^■nlionl four or Avo dayii again i^nulually falling, this course being 
^■ofton rnpmtfxl. Ocourring after typhoid fever, Ktich a t«Di])Oi'fttliro 
^Hoca not ahovr lung disease. This condition may co-oxist with nelCMi 
^Hongu*. increase of appotito and weight, nnd a steady amendment of 
H^w health. 

^H Jt thns npponn that tho tempomtnrv aloao may enable us to 
^BdikpWM tnbcrdo or catarrlutl pneumonia, in coMa whcro the 
^Bpbyaiml signs and symptoms ai« ahsent> or are too indellnitv to 
^■uMKiat tlic diagnosis. 

H Tho following typical instances illusttats the usefulncsH of the 
H tlwrmoraetor in doubtful cases of phthisis : — 

H A imtiont i« taken rather «nd«lenly ill. His fnoo is flnsfaed, cyos 
^^hrighl, pnlse (^nick. The tempenitaro is very high. There is no 
^HlMdnelie, no dcUrinm, nu dinrrhiEA. So wcaI: is he that he «lnys in 
^HRa. At tho end of ten or fifteen days he renukins macb in tho same 
^Kfilight, hut hnK grown weaker. His tongae ban become dry. Thotxi 
^B aro iw typlwid spots, no diarrhuo, and tho Ntomaah is not distended. 



40 



CBROKtC FKVER. 



IIo liBM ncitlicr coujili nor espectoratiun, oiiil Uiore are no phjain) 
eigDB in tlie cbc«t. For m month or five vreeks be coutlnncs in tbe 
BUne Rtate. viuat dialioot )>bj-Mc)Ll xignH nt th« apii-cs uf tlie lon^ 
•ppeor, wcompiuiiud )>jr ox{ie>.7Uitittion. and poasiblj nJigLi lui'moptyvis. 
Soon lie bc^inN to improve, tbe tevnr grows dailjr leu anverv, his 
Uyagae becomes elnii, nppetito «1nii-1f retiiroa, coagfa dimiaisbea, 
find nt )(u>t Uitb oouffli luid exfwi-tunitkiii cnuw. All mnkt clu«l 
HinrilK ilimppottri And nt the I'xpimtion of iibnat two Riontb§ tlw 
tPiii|ifinlur« becomes nuloml, Ktn'nglJt ratunu, kiM vrd^til incrOMM, 
■Itboagb iw will alwa^ii carrj- evidunoM of cotwolidalton at tlie 
npiora of bis liingx. 

A nomiin, Ix-lwveii 30 nnd 3^ ,veara of nge, fsils elif^litlj in benlth, 
eompUine of slight woaicnes8, i§ soon tirvd, but is nover ill 
enongli to be coDfined to bud. Her sppotite is TstWr bad. Tliore u 
n irifliiig oonifb, nud perhaps on one or two occaatons the oxpoctont* 
turn of ft sligbt Rtrt-iik of briftlit.colonr«<d blood, so sliglit end no 
suliloiti rrpi-HtL-d that it is hope<l the blood mnj h»ve oonie tttim tbu 
mouth or thrcMU Tlicru mav be n strong faiuit,v predispiNutioa 
(u plilbimN. K« pbvNicnl figiiw arc appnivnl; jet tJio tom[ivriUnrr, 
rlsinK iiiglitljr to 101° or IO:i° Fab., declan's tbo true nature of the 
dlMMM, 'n-hioli. pvrlia|iii, in thv conTM of some montlis, ducukid 
pfajraicfil signs render too evident. Uoir important it it to detect 
tliis (U-ly niid »l)ght sliti^i.' of thu diseaMi ! 

By means nt the loinperature we can diafrnosu taberculoM, er«n 
wl»en during Ihc whole cvnit>« of the dircose there nrc no physical 
sflfnH indieative of tulx-i-cular deposit in any of the orjcuiu of tlM 
body, and wWn tlie svniptoniK an; quite inadequate to enable as to 
form miflt n diit|niosin. I'lmx, we comnioidy ntuot vritli eaw!* of ncnle 
miliary tuberculosis in children, whoro, tlirou}fliout the wliole onurw 
of the diiieaw, tlie only gniding sjmiitom is prvUriuitntnl hi-at of the 
body, except, ]>orhnps, a small amount of Bonorons or sab.mooous 
riionehus, aiid yet after cUmtli most of the orK^na of tlie 1)ody an 
found studded with miliary taberclos. A^nin, we oconaionally meet 
with pntiiTuts, genenilly among children ti-u or twelre jatn old, who 
omn|ilain of pain in the bond, and whose manner is peculiar, being 
M-nii-iiliotic, in whom llic temperature daily rises considoTKbly tor 
weeks or months, nn<l after deoth small mawes of y^tow tnlwivle, 
the siu of a large pen or bcui, are found embedded in the «nbatAooo 
of the brmia, with Mmwlimoa miliary tnbercloa scattered thi-ongli tiM 
Utomcio and nbdoninal oiftnna. 



1 



1 



l)ltOi>ST. 



41 




ON DROPSV. 

X lieultfa, niitrttiv« plnsma cccapt* from tho blood-voeeela into tho 
sdjaceDt tuaues, and is afU.T»-&rda abBorbed bjr tbe lympbatioM nnd 
]N>s*ib]jr hj tlio blooil-v-nisolif. TbiH tntnsfiigion and absorption 
jcoaoterbalanoo «Acb otber, and henoe only a ini)<l<!ni(« nnionnt of 
fluid u found in tlie parcnulijmnlMDii tisi^nrA. Dut if a diiitorbAnoc 
ariaes iu tho boluice betwem tbese two jiroce.tsc-K, tbc pnroiKrhymatoas 
finid increnEed, producing dropis;, or nnn^nrcn, a condition duo vitkiT 

too Inrgu a ({nnntitjr of fluid trauifusin}; ibruugb tho blood-veseelH, 
to deiicieut absorption. Nutritive plnsma paii:ti-H from tbe 
TeMelM by filtration, difTutiion, or svcrutivci nttraction of (lie 
im for the Buidn in tbe blood. I>ropBj' never probnbly bnp|>Hiiii 
tliroaf;h incrcnscd Attraction of tbo tiiwuOM for tbo plneiua, but 
gtmcndly on BUralion. Tbo amount of fluid esL-apinj; from the 
tCnnieB by filtmtinn dcpcndH nn tbc diffcrencn brtwucn tlic pnvxnrv 
of dnid in Cbu blood-veuels and in tbe paronobytuatous tissues. In 
Ixtalth tbe pKonure of tlio iloid in the blood-rouois is bigbi-r than 
tliit of tbe fluid outside the mpiUaries, and benoe a ooiistant con-eat 
of natritivo pliumn Rows tbrougb tJie blood.vessob to Iho (issues 
outride tJieiu. 

Most caara of gonoral dropsy depend on bydntmia, niid this is 
prodncL-d by diniinisbed action of the kidnuyit, wliiiroby the urine 
ia greatly diminished in <iaantity, whilst the patient takes tbo mran 
qnantity of liquid into tbo Kyi>t<9n) ; hcnoa thu uxciiiia of in(r(!!iti(in 
over that eliminated throu^'b tbo kidneys aoCQinnliLles in tbc blood, 
nnd produccii bydrnmiu, nnd, im Burt«U bnt pointt^d out, tbi! amount 

dropsy is for tbe niont part in proportion to tbo diminution of 
The inaftion of tho kidnnys may lie produncd in three vrays 
— by diaeaae of tJi« kidnoys, aa Bri{;bt'a disease, especially the acute 
ami htty kind; by diminished artenul pnwHuro in lliu K'omcruli 
fn>m general diminution of artL-rial pressure depeudin;; on heart 
diseeao; and on retardation of tbo cii-culation through tbo kidneys 
from venous congwtioD due to tricuspid regurgitation. 

In thoNo formit of Drigbt's disease, tho fibroid or tbe nlbnrainoid, 
where ibe quantity of urine is normal or eren exoenive, there is uo 
dropsy, wbiUt in tho acutely inflamed or ftvtly kidney, in bolh of 
vhicli diaeasea tho qnanti^ of urine is often greatly lesfieDod, tbe 
drt^My is often marked, and almost always occnrs when the quantity 
of urine is notably diminished, whilKt it ia abeent in those coses 
irbere the socrvliun of nriue ia free. 

la all valmtar affections of tlie heart, and in a weak heart, lesa 
blood is propelled into the artttrial ^teiD( and consoqncntly arterial 



over I 
Knnd pi 

1^ 



4S 



MORT. 



tenuoo ix loworcd. Tliw in tko result of eiDpliyeoniA, whicrb hindon 
the paftanfti! of blood iliToui;k tli« InngH. It ik tliv rCKnIt of mitnl 
*ii<l of ROiiio nlTuDtion&. To orercomo the ob§trnctioti tli« liciirt, 
undor((oca ouropensatory bypvrtrciplty. Knd if ihin n jmrfo't tlinn 
itrtoriiil Ifiuioa is kept up, bat if tliis is imjicrfect, or if the left 
ventriulu uftvr lij'pcnropUy undurgoe* divgcncnttion, tliun uncriul 
tvnsioa iinioudinUiljr fullM is tbe glomeruli as well iis in tlio IxmI;^ 
(ft'Homllj-. Xow the amount of ivatcr (hnt filters ihmngb tbu vnilin 
of Ibo vuKMlsio tb« glomornli dependii on the tMBenaev ot latent! 
pnantre iiutde Aiul oatvido tbo blood -TosBels. If *rlaniU toiwi<>n w 
mnch ndxuxd, then low water 61t«rM tbrongh the reMeU, and Um 
water oocumaiates la tho blood. 

Bnt tbo qntintitf of nrine depend* not only on tlie depwo of 
tkrterinl tcnuon in tho roasels of tbe (glomornli, bat alito on thp 
rapidity of ibo circnlaliou tbrongh tJio kidnoT*. 1( nrterinl t«RflM)« 
i« towered tbt'n tlio into of citvulnUon ix rvdnci'd. Bnt general 
venous confuestion from iriciupid rognrgitation alw> IbBMOB tbe role 
oE tbo circnintion ; bRn<-o tricuspid retror^itation in this n-ny towlH to 
lenen tbe accretion of urine and eo to prodncw [lyilncmia. lloir Aom 
bydnemia prodnee dropsy ? Tlie qucation mnoot tit present bo MtiH- 
factorily answoreil. but it !■ often assumed Ibat tbo volume of ibo 
blood lioing incroiued arterial prceonre is augmeutedi hoDce mora 
eeroas fluid fillers into tbo parenchymji, and 6ltnttion is easier from 
watery than normid bbxid. 

Dropay is in proportion tbon to tbe amount of liydnrmim and the 
amount of water in the blood i» goDundly dqwndent on the aotion of 
tlio kidneys. We moot, Itoirever, wilJi osos that at Brst mght 
nppcAr ttxovi>lioDH to this atatement, for wo aoe patients tronbUd 
with exteiwive and progresnTO dropsy wbo pass two, tbroo. or evn 
(oar pints of urine doily ; but it will gcnenOly be found tbnt tboM 
potlenle ore troubled with great tbir«t, aud drink far inoro than they 
void through the kiducyii or Kklit, and tlip i-xociw of tboir driuk over 
the quantity of urine sccamulat«« in tbe Uoo<l, causing bydnrmin and 
dropsy- 
Are «o riglili bowevtr, in OMCrtiug with mmdo writers that mere 
venous obstruction oanaot cause dropsy Uiongb it may fnvonr it. but 
that without noma aBootion of tbo nerrona sytt«m drupHy will not 
occur y Thus, tbo oscendiuk,* vena nnva in dofts bos bom tied with* 
out piotlueiDg dropsy of the |>ostcrior limba, Init on uutting the 
uertea of the ociatio plexms dropsy mmo on unraedialcly ; anil as the 
dMdon of tbe oorves inside tbo spinni onnnl (tbnt i« befon th« 
TiM-mfllor Borrea join tht-m) does not pnHlnoo drapey, it Is eon- 
eluded tbnt [Mmlysia of the raao-motor norrcs is the cause of tlropay. 
Cliniual facts, howevor, oartautly prove thet more venous obslructbm 



I 



will cause tlropsj-. Cirrho»s of th« Hrcr, gr a tamour prcHtiing on 
tliA vena portw, nr coagalation in the vein oft it enters lliu livor, will 
]]t<odDoe ascites. Aro wo to conclndo that theao dUenseB pumJjrKc tho 
vata-taotar ncrvcit iit the abilominal bloiiil-v<'>uM;lN ? Aj^aiii, Iricuxpid 
ngnrgiulion proclacc-s gtenonl anamrcn (Ihongh it most bo ailmitt«d, 
not in piKipOTlimi to the nmonnt of obxtrnction, jndging hy the 
lividity and tUo fnlnces of the jofi^lar veins) ; is it feasible to infer 
that thin uondilHin pnraljxcs tho vn<o-malor nnrvon ? In TcnniiH 
o1«tmction, moreover, dropsj always abows lint and mofet inarkciUy 
in the moiit diipt^ndvut |iurta, wlicrt; tlxi latoral [lrl^«urv on ibo vemi'Ui 
is groat^st, and aro wo to enppoae that the VBtso-motor paraljeia 
lUtackii theto partK tintt, and t hen ^^radnallj- a^oenda tho lower Uiubd ? 
Is the venoufl oongeition t^onseqaent on tricuspid rc;;ur^itntion 
KDflicicnt to iianifp dropsy, or is the dropsy chiefly duo to liydnt-niia ? 
Chiefly to hydnmnio, for wo meet urilli cases of extreme tricnapid 
rogur^tatioD, with fa]) pnlsating jagalarH, much Hvidity itnd dyx- 
pnccft, Mid yet no drojisy, and it is found theee patients pass a uormal 
<ltiantity nf iinne ; but when the urine diminisbce, drop»y seta in, and 
in prciportion to tbo *c«ntin(HiK of the tinno. Still, no doubt Teoons 
oongescion from Iricnspid refpirgitation favours dropny in othur wayn 
than by caunng hydnomia, for diKlenKion of tlie ri^ht side of the 
bokrt, with general venons obstruction, mast lessen absorption hy 
the veins and lym]>baticii, and in this way cause tiiu parencbymataus 

fflnid to accumulate. 
Bemediea may remove dropsy :—(i.) By diminiKhin^ lateral prc«- 
Biure on the walla of the blood-rcaaels, end so lesseninj; trauBfu!>iDii 
from Uic blood- vessels, (ii.) Increasing absorption, (iii.) Bntb 
waya combined, (iv.) By incrcaHin^ tbo lateral preasure in tho 

tblood-vossels of tbo glomemli, and so incrcasin;^ the i|uantity of 
nrtiu). (v.) By ramoring those diaeawd conditioim of the kidneys 
whtrh hin<li-r thvir secretion. 

OifritaliH ia n gatA example of a remedy acting through serernl of 
^■thtt above methods. By its action od the diseased heart it prevents 
^in nuuty caaca mitral regurgitation; bonco all tbo blood of the left 
reolficle is sent into the aorta, inntead of a part twing nvut bock ititf) 
the aDriclc. Arterial pressure is thus raised in all the or^ns, and 
amoDfj'ftt other parta in the glomeruli of tho kidneyii, aod hctDcci more 
nriao is sceti>ted, tlie blood is purged of ita exoeaa of water, and tlio 
dmptty is thiiH alworljcd into the cironlntion, and quickly eliminated 
tlirough tbo kidneys. But it alao acta in other ways. By obviating 
triea«pid regurgitation, tiirou^ ita influoDce on the left oidv of tho 
heart, digitalislosHiniior removes paiaive congestion, diminishes btood- 
pratsunr, and con«Niaently tiltmtion, reduces tho nroonut of tranic 
fuaioti from the bluod-vexKeli', and proTcntu furtlier de^'elopmeat of 



u 



monr. 



ibe drops]:'. By obriatiiig vonous obalniction, it tvmovps Ipnphatic 
obclniL'tion, nnd thiu fitvoum ■luur]>liun by the Ijrmpbuticft; bene* 
th« cic«Ba of {Mrenclipnotons fluids is tftkeii up hy 4li«M TMMb. 
Morrovrr, if tli^ni in mni'li dropKj^, on removing the congMtim, Uie 
preKure of tbc fluidii outride the blood-TMsels vorf probably beroni«s 
gnttter thnn tbnt in Ihr vchmlOh, nnit hence the flnidti ivill flow into 
tbo blood -vetweU. The w&tcr in Ibo iisGUM is then brought Imclc 
inli) the circulation, nnd etiininnt«(l by the kidneye. But diifiluli* 
>lao by it« indirect inilueuce actn oh tbc kidneys. During tnciiapi<l 
rcipnrg^tatiou the kidneys beoono L*on^Mt«d, hunperedi ftnd iunotive. 
BMDOTtng general oongeoliini by ita eflecta on the heart, digitalis 
relieresthe kidnoys, and atlowK them to rettiro to their natami atate, 
luid honco they quickly eliminate the excMS of water in tlte blood, 
due to the abiiarptioD of the dropaicnl fluid. When all tbo wattr ha« 
bl■l^n abtiorbed from the tJAaiics tnlu (lie blood, and eliminated by (ho 
kidneys, digitntiii no longer cna«ea an exiicaaive flow of tirino, a* 
would happen if it acted directly on tlie kidneys. 

It may be urged that we have regiirdiid the drop«y of IriciUpU 
ntgurgitation as in part due to h«iK'>'^'>i^ vaHculnr tonsion through 
tbe jjreat venoUN congestion, and tbst if digitalia inorenaes arterial 
tension it slionld increaso rather than diminish the dropsy ; but it 
mast Iw borne in mind that digitaliH mnoreti the tricuspid regur- 
gitation and rcnons ooDgcetion by the same means that it cansos 
more blood to be rant into the ortirial •yB(4.>m, and so heigbtcu 
art4>riut tension. 

There is another form of dropsy nopding doscriptiou, that due to 
UHDnua. After severe loas of blood, or exhausting drains of alba* 
minous Unid, as in diarrheBa or chronic dysentery, n patiout oft<<n 
bocomee very dropiiicid. A *niiill amount of dropsy at the ankle* 
also ia vommon in utJicr forms of anarmia, as in chlorosis. IIow is 
this dro|i«y produceit ? It cannot Imi explained satiafactorily by 
Ucrilang it to hydm>mia; for tbouffh the >Tal«r is ntlativoty in- 
rrenaod to the nmnnnt of albnmmi and corpnielvs, tlie (otul vidnnie 
of the bliwd is diminished by hemorrhage, and Iherw cannot, 
tJter«forV( oconr tncnwM^l lateral prvMsnre from incraase«l volume of 
(be blood, as occurs when water is retained in the system from 
diminiahod cxcn'tinn from the kidneys; an incivnsed proasnra 
Imding lo increased transfusion throngb the capillaries into the 
parenehyma. 

If not doe, then, to au ahaolnte exccas of water increasing tb« 
total amount of blood, how is tlio dropsy expkiiDod f Is it duo to 
the delicienry of red corpuscles or of nibnmen f It is tiol dae to 
daftciimcy of (lie rod corjiuscles ; for in cfaloro«ip, where the red cer^ 
poeka an greatly dimiuishod whilst the amount of albumea nt- 



I 



I 



KITECia or COLD OS THE BODY. 



45 



launs ranch tlie tame, verjr little or no dropsy ocoars, and it U onl,r 
in those aao* wlivn IImi blootl is i^^ntly drainctt of filbtimcii tlint 
ext(>usirei dropsj* ensaes. TUa dropsy, then, is due to the want of 
klbiimcn, nntl it id known lliat nibamen htua nn aflinity for wst^^r; 
and it ia concluded that, being dimiuisbed iu quaniitj', the blood lias 
1ms liiSiiitjr for the Ruidit in lliu paronchjrmii, and hcnco tbia luioumn- 
latt« and prodnoes dropey. If tliis eKplanation is correct, wo have 
hcT« ft dropKj due «tmply to iliminiubnd abBorption ot tho paronclij- 
mtttoua fluids. 



THE EFFECTS OF COLU OX TliK BODY. 

BRroKE treating separately of tb« varifliu kiudx of cold batlin, I 
think it will nve repetition, and prove otlierwisa nsofiil, to make 
some preliminary remarks ou t ]io ofFoctn of cold on tlio linnisn Imdy. 
Thtwo effoctH arc vftrionM ; ncuonlin^ to the way cold ia employed, 
ttiaa nfrifferator, an aniesthetic, a tonic, an excitant, <ir a di.>prcs»nt. 
Tho a]>plication of cold witbdrnwi heat from the body, and ooola 
both the saperficial and doop part^i, Tho general cold Imth will pro- 
dnoe ft vt-ry coiuidcrnbli.' radiiclion of the heat of the atu-raue to the 
extent even of 10' Fab. in tho tmnk, and oven oonsidorably lower in 
the exlreuiitloH. The genumi cold balli might bo aappoxed capable 
of redncing the heat of the body's snrfaco for a considerable tinm ; 
thin, bowover, i;i not the coui, for the Hkin of tho tmnk Hpcpdily Ix;- 
coumb warm again, allliongb for Aomo hours afterwarJit the extremi- 
ties may remain cold, and the tcmpuratnro in the axilla almost ro- 
oorers itself iu a fow mi nutfs. although the bather may have hwu 
^K inunerwd bftlf nn bonr, or lonifor, in water at a temperature of fi'}'. 
^U 01 course, it in not here maintained that hctnt in not ahxtnuitod 
^m from (lie body; liut, hh will be shown in another place, the loss \aBO 
^K rapidly restored that the cold bath will not dcprcxs the nkin'a tcm- 
^H pernturo in a be*lthy ]icni»n for any notable time. 
^M Cohl sponging, so ofttm employed in fovow with snch cviihnt 
^K nlief, exerts a very nHnht and transient inflaenco on the he»t of tho 
^B||^y, as may be ascertained by aid of tho thermometer; hence the 
^^■sKmj of comfort derived from the sponging ennnot be described 
wholly, or hardly in part, to its refrigerating inflaenoe. Thin mlirf 
may Iw duo to tlw removal of impnritiea whicb perhaps irritate the 
akin, or annny by theu' odour, and by mitigating tho parched 
condition of tJie snrfftcoi for a skin brith hnt and dry is a source of 
mnch greater discomfort than a moist though even hotter skin. 



46 



SFncTS or cols os toe dobt. 



Sponprifr i> itli t«pid water, so &a to resbocv niobttnre to the porobed 
akin, pivos mnrkod comfort io tli« paUoitK 

The fonyoinK nDoorks appl^ only to tlie sarfacc of the body ; bat 
tbe general cold batb will likewiso reduce the tfimpcratiiro of the 
intnrnnl orgniut. TbiN ri^diictiou, UL>ver Tory (trcnt. jk tvntoivd to tlio 
dvep even mora quickly than to t]io snjierScinl parts; w> that, m 
mijD^ht bo infem-d, tlii; gf^nt^ml rold lath is sLtll leM officient as it 
rcfrijfcruior of the iutemal thao of the supi-rilcial OTf;*aa. In fpver- 
frM persnnH, tbcrcfoiv, the gnnrral cyld Ixith must mnk vnry low a* n 

It is IwwoTOT, othcrwjsa with iho Ixidy of a patient wboM< Km- 
pomturo is unnaturally raised with fever. Tho immemion of fever- 
etrickon patienUi in the csold batli, nr ptK'Icinc; them with the cold 
itheot, will prudooe ti considerable and durable Uiwcriii^ of the Ivu- 
peratam, Wliothor this irduction is cffectod hy abstraction of heat, 
or by proventing it« annatural formation, it is impomibla Bt pnwont 
to decide. 

Cold, when judiciously i-niployod, is ttcII known to be ti ponvrfnl 
tonic. A cold clitnntc and ookl bathing are tonic aud bracing;. Th» 
thwry of the tonio notion of cold may porbaps bo ntntcv) that ; — 
Dnrinj; rxpMuro to oold, tlie body's loss of h«at, as tested by the 
IhcrnuitncttfT, i» l>y no mcMu a nieniinre of the <inantity witlidruwn. 
Many observera hare shown that at such tinus iuoround eomboation 
occnn, whet*by much of thi- loal boat is oorapvnatvd, and tha 
tempemture is mninUtined or soon Kstond. This inoraaaed oxy* 
4lution of Ihn limiuea is demonxtnited hy tho greatly increued 
(|nntility of cnrbosic acid thrown oH by the lunfia on exposora t« 
cold. Now the niottt vifioroBx health w mainlninvd by a ra]>id Cnn- 
stmotion and desUuction of (isauee. within oeitain bon&ds, provided 
theao (wo proomea nra fairly bnhuiccd. On oxpoaaro to ooM, the 
lun^ shaorb moro oxygen, the tissnes arc inon rapidly and fnwly 
esydtxodi and thns the proccwtca of dentraotion ana) rej»nitiun go 
on in lar([«r measure, llow is lliis elleelcd i' 

In (he proccMof nutrition, apart from Iho Dorros, wo harv thrve 
faolciri, tlie nntrilire plaama, the tistues, and oxygen. Wbaa focx) 
In tnlcpo, di)fvt(vd, and inlrodnoed into tho binod, Iwith formation 
and di'itruction of tho nilroi^aons tisraiM bogttt, fonuniiun b*in|f 
limitMl in destmclion; and mIicr tbo dcatmction of tissuss <wuai. 
II141 further assimilation of Ihe nntritire materials of tita blood ooiww 
likewise to an end. llMtiin dawlruclire obangea lake ptaeo in pro- 
porlinit Io l]io amount of oxygen alworbed, and nbvn this frn* >" 
vxliauktrd, many products of ttestmetioB remain only )i(Lrlially 
evydlxod, furthnr tisaun disiulrgmtion ccuus, and aMioiilalioD is 
MUpaadvd. (Parkea,) 



COLD mnr. 



47 



lot 



Under exposure to cold, oxyj^] beio); almnilnntlj nbtarbod, tbs 
eff«t« prodnot« io tbe blood kkt first conaumod, Ihaa porif^in^; the 
blood, mad nnderini:: it ftt to nonrUh tho boily; iK'xt, bj its 
consuming' action on the tissues, oxygen promoter the oyole of 
vhan^'s jtixt denaribiil, food ix lalcon and Muiniiiitlod, An<l tho 
destruction and constraction of the tiasaes rapidly go on. ho creating 
(fNKt plijxioal Tijjour. Thiu it is tliateold cliintttvii luv inTigorating. 

j|j)pl)od locally, cold may n^t u a tonic (see Uonobe) ; but H too 
]0D{f ooDtinnftd, or «;xo<!Wiins it depr«is«; for, by contnu-tinj tho 

'8«i!l« too sharply or too cootionoiuly, it lessens the supply «( blood 
the tiflsnM, and thereby dimintMbcs in them cclbgron-th and ti«Bao 

langu. Int«n»e oold, applied for some minutcH, n-ill ubolitdi hcdm- 
6on. and in this wrty hccomnit an nnreKthvtic ; and, if tJie cold is too 
loiur continnitd. thn pu>rt will did aud become (i:a»)CT^uoiiH. 
I The aodden partial applicatjoii of cold may act as an excilaut. — A 
cold hand applied to tbo abdomen excite.t cciiilnmtionti in l]io par* 
turiont womb. Cold water smartly Bprinkled on tho faco of a 
BWOOninfT porson in a familiar wny of rvntcirtiig con«ciou8ni.>ss. I'ho 
nme tnatmunt will help to establish breathing in weak or a^iittn-ntly 

ill-lnm childron, or to rooorer personit ovitr-doKcd with cliloroform, 
ir narcotised with opinm or tipple. 



THE COLD BATtr, INCLCTOING SEA-BATUIKG. 

^Cou> wntor may bo applied for tho sake of its inni«lnri>, its t«m- 
%tan, or both conjoined. If we rcHinin^ moroly moLslnre, nnd 
ipcrntnro ia of no oonsequeuoc, topid or warm water ui lioth 
pmferaUe and more a^reoablir. Cold water in gooarally employed to 
ftbatonol beat from either the whole surboo of the body, or from 
uie particular port of it, or to indnoe goncnl or local excitement 

Kltoi-k. 
8inoe tho skin abeorbw neither tfao water of tlie bath, whether it be 
' warm or cob), nor any snbstancce. solnblo or inaolnbie, which may bo 
added to the wxtur, it fnllowM tlint whiitwer may bo Iho offset of baths 
iitmn«t Ijo explained by their direct action on the &kin. Ur. StUlj. in- 
deed, nsaerte that some ab«nr]>tion takca place with re«pcot to kuK 
I atanccs di«olred in the cold bath thongli not in tbe hot batJi ; and 
[ J)r. jLmory confirms thiK irtatcoiunt conoeming bromides, for in a cold 
I batJi, be sayN. a " smitlL u[iu}unt may be absorbed," bot in a hot one 
iof 9<>* til Jyti' Fab, none. Tho qnaulity abtiorlicd, howovw, is fai- 
' too amolt to invalidaU: the for«^ing general statement. 



46 



COLD BJlTH. 



In uponkinfic of tbo geneml rolil batli, vrc ttbull cpnik initinljr of caM 
soM-bathin^, this boing a far mora pon-crfiil meiliciDal ne«nt tluiii the 
Bimplo imld bntli, allhotiKh, indoud, llitiir at-tion ix identical, the dif* 
foTcnce in their eSocta bein>{ OM morely of defn^e : aud, as wo pro- 
cecd, vre Khull point out how these difforenocMi nffeut tho body. 

(hi ent«ring n oold sca-lMth, thcro is at first a sensation of depre^ 
«on, RratI or little, according to the coldnrss of tho water. Tho ekin 
bwomes [lale and shrivelled, ami preaenta the faiuitiar appearance 
•'g<M5«i-«Win," a condition product by tbo contraction of tho Kkin, 
and tho consequent protrniciun of tho bair-rootii and foltiides. There is 
B gv^noriC iihivering, somo bluenoss of the lips, noge, and oxtromitiM, 
<iODa)deral>le redaction of tlio temponituro of the alcin, <|nio]cftiied 
pnlMT, conviitsiro and sobbinf; breaching a» the water rieea to tlio 
chest, espociidly when the bath in entered idowly. Tho inr>>(«Ri aoon 
bocoming ronsod to moot and to Teust the deprosaing elfocte of cold, 
in a few M«ondK ii KcnMtion of general exhilamtion cnxuea. Tlie altin 
lieconiea niddy and glowing ; the breathing fall and easy i the pnUa 
rather quick and utrong ; tho xpirils exalted, and the bather feel* in- 
omsed vigonr, both of wind and body. If he qnila the both now, or 
before (ho [leriod of exhilaration ooomSi the baoyanl condition oodurea 
mora or less for tho redt of the <lfly, showing tliat the tiatli ihuii nets 
n« a tonic tn ihesyiteni. 

On the otJier hand, if the batb U prolonged, dopreuion again eonws 
on. Tbo bather feels cold, shiven. beoooMB bla« and nnnb in tlu> 
mora exposed and Ninatler parts, whi-ucc, on aouount ut their *in, 
wnnnth ia ntora readily withdrawn, and he is soixed with a wnKatioo 
of dcpreMnion aiid w retched ncn. Ballu prolongeil to tliia injudicioaa 
oxivnl often produce damaging results, which niay conlinno for hourit 
nwl even diiyH, •omolinuM, indeed, inllieting acrions injury on tba 
health, specially in n weak or groning person, For many bonni 
after the batli he oon)]>Uin* of general languor, with a r<^agnanoe (n 
oxercise, whellier of Imdy or tnind ; his temper is fn^tful and tsoraWi 
ibeoiiTnUlioTi feeble and languid, with lunkinic lit the epi^-ruitrinm, 
loss of nj'jielile, ehillinetia iif tho stirfaoc, and cold extn-miti^ii. U 
ntmi Kmreely be Mid that ci>nNeqni-n(i!N like thooo aru to be carvfnily 
aroidnl : yet these ri^ks will often l>e oncoHnterod, uoless tka doctur 
gives Njiocihi- and minute dircctionN, ho grant is ibe prevailing ignor- 
nnnt and em>r im the subject of bathing. 

If the expoture in lb* cold fa»th ia continued Wjrond tfais point, or 
if Uu) colli \» Bonn, lis effects beoomo mora manifest; great depn*- 
BJoa and a latmlioia of utter miNrry M't in, followed ahnrtly by henri* 
UCMi and droiratnan, wliieh div[ien sometimes into eonio, till a kind of 
api))>lcxitiit stale ia ratehe*!, then asphyxia and death from pnntlysis of 
tito lanseUm ut ntjdntvm. 



I 



I 



COLD BATH. 



49 



^V BnUui. then, on the ono hand, jodicionsljr omplojedf ara vorypowcr- 
fnl tosios, wlul« on the otlier, if unwiaelj nwd, Uuijr indnott grent 
cl«|»«mion of tlio Uidily ■povara tatd produce Mnoos minliicf. The 

■ flaperiority of aeA-batba has been placed beyond more rormi§e{ fur 
liiivct pxpcrimonl bM cstttblishod the fact that a sea-bath nets fu* 
more ponrcrf ally on tiaaue metauorpboai* than ibo simplo watcr-balh. 
While tlu) HCA-batb tacreases tho process both Df destrnction and of 
coutractton of tiwtiiR. yut that of constrnction is in cxci^kh of thai of 
dcotrootian, with the effect of induci&f; not only iocrc^aud vig\>ur of 
Omi fnoctions of the body bnt an anlual angaentation of its weight, 
Sm-air. it ta trne, &eta in the same way, so that it la difGcuIt to deter- 
mine to wh»t extent impruvxid houltb rvvults fram tea, cHmate or m^ 
H baths 

^1 TUe cold bntii is almoat nnivins*lly smployod for its tonio rirtno. 
^m To obtain tfaia wisbed-for result, the bath sbotild bo dixxuitinced at 
^B tli« tim* it oausee g«nenl oxhilamtion, for the qrRtom tbea appeals to 
^p be ronBed into action ta reaiat the depreuin^ iuCucn<!e of cotd, and if 
at this point tJio liath is dispanlinucd the gmcral healthful stimula- 
tion pursista; for, whiUt lakiitK the balh, and pivlably for some time 
afterwards, oxidation of the tissnos is increasod> the blood is purified 
of effete products, and the prooe«* of ooniitraotian and deatractiou of 
linue, on which vi)^ur of both mind and body deponds, are intcn- 
■ified. 

BalfainK* therefore inoreaaoa appetite, improves digntion and the 
assimilation of food. The batli, then, is a Ionic in tlie Htrtctcst sense 

Ief the word. 
Ur-iI in uocordance with the mien to be immediately Inid down, 
ihe good effect of the bath huou becomes apparent, and the [mtient 
^ins ID weight, bi« com])Ipxion becomes rndily and oloworr his 
mnscleti, eapeeially if he eoujoins exeroiae with the baths, aoqnira 
firmness and strength, the nicntiil debility arising from deficient 
nntrition of the norvoiis i^stem speedily pu^aMm away, ard ho soon 
rocorera mental and bodily rigour. 
^B The important qncstiou arises — Uow can we beat obtain those 
^Knvigorattng effects ? 

^H Onr object clearly ia to acanre the greatest pouible amoont of 

^Btimuhition, and to ensDre as long as possible the porsiBtenoe of the 

^BDcrcased vigonr of nntrition. To obtain the greatest degreo of 

^^timalatioR we mnitt dniy apportion the temperature and duratioo 

of ttie bath to the patient's strength ; nn<l to ensarc the oontinnaooe 

of nntriiirc vigour ua long im pus-iible the patient should leave tbo 

hnlli at the climax of general exhilaration and stimoUtion, avoiding 

carefnity the onset of tlie next stage, tliat of depression. 

^m The bather, if very weak, man ifoeta but littlo fanctional enargy to 



£0 



GOLD BATH. 



rosiat tlio d«preuioii from the cold. Indood, if Ithis is inttrnae, tlie 
8tagu of stimulaLion mar not como on M all, bnt, deprosu'd from tlie 
drat, tlio pationt may to remain for a ]oag time. InjnclicioDs bath- 
ii^ ofUn iierioiulf injures, and oven cndangen tho Uvor of wckktjr 
persons. 

The depitMiing vSoctn of n nold batb ara proporiionc>d to it« cold- 
Dees and doretion. The colder tho vat«r, the greater th« depceeaion 
it oocanoDR— gniiter, too, wboii the wntor in in motion than wboD at 
rast. Moreover, the longer the period of immersion the greater is 
tho ilug'rvi' of doprossion. 

^Vhen tlie pntioat is weak and prowtmtod b^ illness, th« batfa 
mnM not be too cold, nor continaed too lon^, and the water should 
bo at rest. Thus, wo mtut bare regard to the strcn^h of the 
patient, the tomperatnra of the w&ter, and the daration of the batli. 

Hen it will be convenient to conuder in what rospoet soa-balhs 
differ from simple water-baths, and to explajn the tonic saperioritjr 
of sea-l»ths. 

1st. In sea-water vanons ingmlivnls are held in tolation. 

2nd. Thu rariittions in tompcntaro of sea-water, in tlio rarying 
seasons of the year, are murh I«m than those of river-water. 

3rd. While tlui sea is alwsjrs aiaiv or toss in motion, river-water is 
coaparativolj at rest. 

Tlie salts in solution are supposed to act as invigomting stimnlants 
to the skin, so that a patient unable to batbo in simgdo water wilbont 
snjfvring gn*i deprassioti can bathe in sua^walt^r with great benolit. 
Uurvover, as the sen's temperature never falls VD17 low in wint«r, 
■MuWlhing may often bo continued late in the antumn, or even into 
the t»r]y winter montha. 

The motioD of the waves inorauios thu depnaaang pffocts of the 
bath, hot if the batlivr in stronK enongh, it also inereoam the ensninfr 
tnurtion; and thus the coounotion of tlie waves, vrlulo more bracing 
to the strong, is at the tame timo highly exhiloiatinff. 

ThiM« (n>>din^ principles borne in mind, we shall bo abla under aQ 
circnmstances lo giro correct anewers to the variona qnestioss 
patients ma; pat to ns coocemin^ bathing. One most frequmttf 
naked is — How long shall tbo bath bo continaed ? 

Onr anewer mast be regulated by tbe strength of tlie patient and 
the oohlneis of the water. If Uw water iacotd.or Uiepaticnl is Tsfj 
weak, we nost at fimt turbid ont-door naa-bathing and sulmtitotw a 
tepid Imlh, tiM tomperatuiv of which should bo slowlj rvducvd until 
E that i<f 1I1U soa is rwtchMl. Thun. if tlie day is line and the sea cbIuv 
f lhi< Ikith majr be lnki<n in the opni nir. Tliongh il uia v be eoasMBtvd 
mto to l^t thn pationt Uthii in tlin mo. jct if ho is vi-rjr weak and 
BBaoonslomed to bathiait. his slaf thoru must beverjbriaf) ttwQl 



I 



OOLD KATH. 



£1 



fcCton inlBoe to allow two or three waves to pnsa cnmpl«t«Ijr over him, 
Kllta ha altould at once come oahore and wipe lilnuietf thoruuslil^ 
dry, nsing plenty of friotion to thd skin, for which porposo Cnsh'e 
towels are well adftpted. With incrtiaMng iitrcnfi;tb, and bc-oomin^ 
stccnstoRuid to the effects of tbc water, he may continite the bath for 
a longer tune, bat it in seldom atlvigable fnr n coavaleacent to hutbo 
longer tliMi from fire to ton ininnt<-K. Somo paticmt^, uay, oven 
MUDS heodthy penoDH, car brar n Ata-Kith only eveiy other dfty. 

Then ss to the time of day beet sailed for bathing tJio grattvst 
ignoRuice prcTiiils, boforo bi«*kfiutt being onTrently believed to bo 
tlie best lime ; yet this pmotico i« not without risk even for tlie 
TOlxi«t,wfao ILTO often made alliuf; and fatigued by it for the rent of 
the day. 

Our object in uitng t!i« bittb. as we have before aaid, is to obtain 
prolonged and energetic stimnlation. We mast thorefore choose that 
time when the body is moat refreshed, invigojated, and nnurishud. 
These conditions, it might be supposed, wonid co-exiiit in the early 
morning after a Hound and refreshing sleep. It mnat be borne in 
miodt however, tliat before hrealcfiwt the body hnn nndorgene a Cut 
of feveml honrs, and is in want of food, withont which tlie bodily 
fonctions may very imdily Iwcome depressed. In fact, only a robust 
person is ahln to bvur a nea-balh befotv breakfast. 

Thus theory and practice are both opposed to this period for 
batliing, ItoUt pointing to a time betwtfen breakfast and dinner a* the 
most appropriate. 

Tbiti Icuts ns to the conslderutian of tuiotber qnestion i namely, 
aft«r a meal, bow long a time sbouUl pass before a bath may be 
taken ; and, after a hath, what timc! sbonld pass beforv ttiking food P 
Now oold bathing produces a great shock to the skin and system 
generally ; and any powerful mental or bodily impression will pbock 
or won arrvst for a time many of the fnaotiou, even If in active 
operation. This is the onse with digestion. Any great excitement, 
it b well kuown, can stay this process more or loss completely, and 
tlie cold bath is genorally safficiont entirely to arrest it ; therofure, 
hefore the bath, an adeqnate time shonld elapse, so as to permit the 
almoat complete digestion of the bmkbst, thnt ig, an interval of 
aboat thrae boars. Nor, for the rensons just pointed out, shonld the 
batli be taken immediately before » meal ; olberwise, little or BO 
goatxic JDtw is secreted, and food lies half -digested in the stomncb. 

And for a reason somewhat similar, the Imtber shoald not go into 
the water whilst under the inHnence of any great emotional vxcite- 
^toat The nervoan force (on which there appears to be set a limit) 
■tiag directed strongly in one channel, the bath will not produce 
HeTTOtis sbimnlatioD, so that the patient will feel languid, cold, 
I E 2 



52 



ooiJ> lum. 



Khlvcring, mad AopntmA. ObvivuNtjr, far the same reoBon, childraa 
nanst be ooued, not draf^ged into th« wutvr agniiiNt their will. In 
ittrly lifo tJioru !s often miuih terrat nf Inlhinf; ; and if, in spito 
of this, the child, while screaming vitii fright, ih forcibly dng^ttid 
into Uio MW, vorj- ill «ffi«it4 vmij fi>llow ; for, tui§sing tho st«g« of 
sUmubrtioo, tlie child ta»y remaiu, ofun for d».y», dcfireaaed and ill. 

In thore anjr ago randeritig w*<batluiig daageroue, and to be pro- 
hibiiMl ? 

It is geiMRmllj acoopt«d thnt j'oang children, — «ay tuider two yttn 
of age, — being Turjr imprenionable, ought not to and*^ tlio abook 
of a cold ■G»-batb, At tba other extromo of life, when the enfeebled 
powera of the bodj ara incapable of strong reaction, wM^hatliieg 
la iniMlnuMible, for it iH an wull known that in old people Ifaa heat- 
foreiiBg force ia mnoh tmIum!)!. UoruoTcr, nnduo vaacular excdtc- 
BMtnt msjr prorc <laugerons; tlia VOMela in the agod, often brittle 
through dcgeuemtion. are in danger of giving way. and thns tuider 
anj nnasoal ntnin caosing apoplexy. 

The for^^iiig rooisrlui imply lliat fatigne is a oonditaon strongly 
adin-Twi U> cold bathing. Kvcn if oLlier coaditiona are faTOonble, it 
is wldont adTianbto tor WMklj ponuiut to take a bath on tbo day 
following tlieir arriTal at tho aea-aide. Tboy shoald wait till all 
fiitigoo has passed uway. 

l)ou« pregnancy forbid MD-batlung ? 

If a woman haa misoarried or abortod, or if of an oxoitable teni- 
perooiKDt, baths nmy be exjwctcd to do harm ; and in far advanced 
pregnancy a sea-bath may ]>erhupit [imdnoo abortion. Bnl nnder 
uthcr circomslanoee, and with due regard to the ixinditions iKWvionaly 
laid down, bathing will benefit both mother iind child. Nor, if 
acuuMtontcd to tho practice, need a woman discnntiunc bathing at the 
meuAtmal |ienod, allbougfa it is always inadrisable to brgin at anob 
ft time, since the shock may check or airast the aecretMni, and this 
indnoe perhaps many luunth* of aiu«Dorrhcca. 

In tbo choice of const, and tlto tinw of year, we must have regard 
to the oonditioii of the puliout~ If not very weak, wit^ the boaltb 
only a Uttlu undortninod, then a mggod coast, when lite sc» b rough 
Mul boisterona, should be reoommL-ndud. However, should the hnsllh 
be ranch brokeii, tJten a smooth sua is priifenblt<, and, in awld 
fllimt«k tho snmmcr is the only ■nitable time. M 

ExercisB takon whih) bathing sooo induces btigne and eno n*' 
lianation ; whvnaa weakly pattcuta must bo cantionud to be nodinaU 
in tilts rospeot Anolbur oril shonld bo guarded against : on Wrinf 
the bath, a palMUl inrigoimttxl by it is in danger of taking too 
miKili eierdse, fatiguing hitasolf, and so ounDtenK'ting the faatb'afl 
Kood aOect. TIm amount of oicrtion pvraitiUid must be etrictly in I 



I 



WU) BATB. 



S8 






ic« with ibo pnticut's condition, who. if vcrv weak, ahonld 
take onlj horse or camafrc L'xvrciK. 

A coarM of Mu-bnthiDg sametimes caDses the hair to fnll <>ff 
■bnndantlj. natarally cxoiting mnob anTiuly, L-sp«ciiillr in wnnien. 
Their fmn:, hcivcror, may be qniotfid hv the aaenraooe of ft npid 
n<.'ir growth. Other Ircnbloa may tuim!. itiithing' nninotimcB indnCM 
coDstipntJoti, more or leas obBtin&to ; but this need not lead to the 
diveontiniuuiae of the hath. The ooniAipation Hhottld }k removed b; 
exeniae, regulated diet, or, these failing, bj purgntivoH. DfRpepsia 
md diarrhcEA ftlsa HOinetimaioooiir during ii(Ta-)intUio(r. The bnthor 
ifaonld bo discreet fts to the hour of the bath, the time spent theteio, 
ud if, notwith«l4mding urerjr core^ dj«peptd& or diarrhceu con- 
thuim, the bath miiat be temporarily or pennan«ntlT discontinued. 
In tad, lea-air alono will, in nonio iromttitutioiin. indni'o IhuKi di«- 
orden. 

RestlcwDCNi at night is somotinic'N attributed to Hca-liatbing. JiImbj 
people^ no doabt. Rud that living too near the sea-shore often prodooee 
broken and steoplen nights. On the shorvs of the MeditcrasnmD, 
Mpecialljr aIon|f the Riviera, thia is notably the case. On retDonl 
iniand, n mile or thcroabonts, this rcstlcssnRSS vani«h<« : for tnEtaDce, 
elcep uoattaioahle at Caniicx itself i* secunxl at Caniiet, a mile or so 
inluid. Broken rest mnf often l>n tracod to dietetic irroguUritios, or 
to Uto honni. A late and bea\7 m««l will sometiinea caDSU re«t. 
leesaiaea, whilst a good night will follow an mrly. light, and digestible 
re|)ML Some pivtionUi mivr their rest hy taking BtimiUaat« shortly 
^before bedtime, while, on tho other hnnd, others cannot sloop without 
" nightcap." 

A Ittlhsr sbould plunge into the wavcji ut once, and on no account 
stand nndroseed and hesitating till ho becomes cold and ahirer*. It 
is ft common and pernicious error to sappose that it is mcMWy to 
well cooled d»wn before plunging into the bath. If needful, » 
brisk walk should be taken just l)cf[)re tho hath, to warm tho 
nod extmnitioH. 
The effect of cold is, in jtroportion to its degree, to lesson the par* 
limtion. A cold bntb at 6n>t cheukii pc-npimtion, hat soon after- 
this secretion becomes considerably augmented, and in a 
degroc aft«r sea than aflor simple wntcr-ba tiling. Drivt^a 
m the skin, tho blood flows into and fills the internal organs, and 
kidneys partaking of this congc«-t«d stato:, probably explains the 
frvqnent and (rnntitory occurrence of a small quantity of alhumon in 
tbe urine, during the batb. 

The affects of cold baths on tissne change Iiave already been pointed 
oat, and the observations on this subject will be stipplomented and 
eenSrmed in those wc havo now to make relating to the infiaeim of 




M 



COt£ S&TB. 



e««-bath8 on the oomBUtcenta of llie urine. Bnihs aagtrent the 
qtiaalitj' of uren or Enlpburic aoid of Dm artu«. Wbetbor tbic 
iacroue cocceedii tlui liiciu of the nalnral healtlij Tariatioiu, and 
wbetluT tlio oxperimonta are BDffidcntljr DiimvraDH to prom it, luts 
boon called iu ^neation. It is not to be expoctod that the tians 
ohaugv would at once be greatlj angmontod, nor tliat tbe incrcoM nt 
anj lime n-uold vxocvd the inaximiim aruouut of hoakb ; coowqueotlf 
tbi- incraafio of uiva in itH turn would not exuwd tb« maxiniBiB 
quantjtjr excrvtcd in lieallb. But hokIjt, if for Mmtt time tlui 
oxcretioD of urvu is maintained at its maximam, thin mnglo fact 
wonid aJoDO establish tho inflnvnco of baths, io far as they could be 
oxpedod to opetuto, and wuuld show that sea-lAtbing incnweB 
dieintv^TStiou of the nitrogenous dsiron. 

The effect of aea-bat]is to promote tissno chango, and to iucroaM 
tli« separation of urea hy tbo kidno^F") i^}' ^ '^'^ demoaMratvd in 
another way. 

Tbo incnHwod ooniinmption of food induci'd by the uxe ot cold 
batJis must bo stored up aidier in tbo bodj- or bo separatvd from it 
by Ibe kidnoys m nrea. Now although the weight of the lMth«r 
undoubtedly inoreoaca, sUIl this augmentation is not commonsurata 
with llic increaso of tngcated nitrogonoutt mattim; tbero muxt bo, 
lii«rcfoT«, nnd«r tbeae circumstanei.-a, an additional separation of urea 
by the kidneys ; bnl if th« pnvalent idea is oorreol, that all nitn^ 
g«iM>us iiinlt«ra must Aral be transformed into tissne befon thoir 
dtiiint«gration and reduction lo urea, it follows that aca-bathing 
likewise {MtnootcH tis:>nu eliangc. 

Bcnoke's obaerrations lead to the ssmo conclnsion. When food 
was taken, judt nufficii'iit: to nuiintain the weight of the body at a 
fixed point, bo found that Ijatbs immediately rodacod the wei^fbl of 
Uie body, a k)W certainly doe to kcifthtoned diNtolvgration of the 
tiMBca. Bnt this inorvased consumption of tbo tissues being accom- 
paaied by incroastid a]>p(ttit<t, and by uicrMscd assimilation, more food 
is taken, and his body gained in weight. Baths, it was aaid, incix^ 
tho (juiuitj^ of nrio acid, alth»iigh thin in Icaacned by aoa^r; boion 
this point oheerrntinns arv an yet iii!iuQI<:ionU 

The nrinaiy water is tomporarily imd often gmtly iDCreassd. 
thongb the whole day's urine is leaened in quantity, pn>bably owing 
to the eabeMionit axoossive eh'mination by tbo skin. In Bniieka'a 
ofaaemtioB the latostinal Mxrvtiona went also large, so aome water 
may hare esnapod In this way. 

It in ncarcely neooaary to oeonpy much kjmuo with a narration at 
lli« easra likely to derive benefit from sea-bathing. In ehnmic illneHi 
BttaiMlwt by (UiUlily sira>lathiiig yields the beiit rmulta; bnt it is 
eapaoiaUy nMfol u> thow rvcorurin; faoot aentu dtienses, and to 



ox MCKIKO VITB THB VRT BHEfT. 



KS 



'-peraona wlmte honlth hiw bcctn broken by over-work, by reaideDOe in 
towns, by sedent«7 employment, or hy tnjiiriona Oxoomob. It ia a 
qnottion of nncb iinportaiioo wbether jihthiaical persoiiB shonld take 
•M-batlis, BD(1 oar Aoawer mnst bo qualiBod by Ibo cii'cti instances of 
iko cuxr. ^VbcR the diiwiuio in (.■hronio, with Httle or no clovntion of 
tempciature (little or no fcvvr)^ wh«n, indeed, the caso is one of 
fibroid ilogvneration of the Innga, wiUurat ftativo do]MHition of 
tubercle or scroruloofi piieuinonift, am-bnths mivy be permitted, dao 
ngu<d hmng pnid to tbo mid* ]D»t laid down. 

Wlien tlie cold batb or cold sponging cannot bo borne, it ia oft 
nasfol vigoroasly to rub tbo hotly with a towel wrung out in topid 
or cold wiit«r, or the naked patient may hare a sheet wrong out 
with cold water thrown over hid Hliiraldcm, and be rablwd down witii 
tho Mhect. Tliia plan ia uaefnl to prepare the way foi* the cold sponKe- 
bftth, and is applicable to the Kaino I'biSH of oueit, ninoo it oxciica 
rCMlion and prodacea dune cbaof^e and stimulates di^^ostion; likfi 
the aea-bnth, it is a tmo toni<!. It i* uacful, too, to relievo fatigao 
after a hard day's walk, Ac. 

Tho aitK-bath is largely and beneficially uned in hydropathic insti- 
tnlions. The water should be between 00° and 80", and tho patient 
sIuHtM ait in it for fiva to thirty minutes, once or twico a day. It 
aIm greatly relieves fatigue or soothes nn irritable rettlea* atato of 
the norrous Kjatem. It often locnona hcadacho, and rognlates the 
bowels ; it often angmente the catamenial flow, and is in many 
inMuDCoa nHiiftilly emplojed to procare uleep. After the sitK-bath 
reaction should be promoted by fricton or exercise. 




ON PACKING VnrS THE WET SHEET. 

pAGKiNfl witli tho cold wot Khoet, although at proaont aoldom oin> 
played oateide hydropathic oBtabliahmaata, it undoubtedly, in many 
diaoascB, a rory etScacionit treatmant. 

Dr. Johnson, in hia work on hydropathy, direoU the pntiont to he 
placed on a mattroea with n pillow to support hia heftd; then, " npnu 
the nattreaa, and extonding over the pillow, two blaQkct4 are aproad, 
and over thia a sheet wrung out as dry as possible with cold water, 
Tho patient li«w down on bia back, porfnctly nndothod, with hb 
head comfortahty placed on the pillow ; an attendant now approacboa. 
Bay on the patient's left, and first pnckirriiig the blanket from the 
hack of the head down to the back of the neok, reaches acroas his 
cheat, aeizos the right upper comcra of the blanket, and bringa tbeia 



56 



ox nCSIXO WITH TBI WKT SHEET. 



liffhtlj across nsder Uie cliin to his mm aide (th« l«ft), ud tnoka 
theoa wdII muI nronlv nnder Urn left tihoalder, wber« it joina ili« rooi 
of the iivck, and under iho point nf the iuuii« fthonliler. Ue noir 
roociiM ocroN ihe body again, and brtoga or«r «11 tbe rCNt i>f ibe 
rigkt wdee of tbe blanket* to Ibo left iii<l<i of the patient, and tbcn 
pdrocwds to tack tlictn well and eronly andor tlui l«ft aide, bo^ianing 
where be left uSI, at the potnt of the nhoulder, and proceeding quite 
down to tho IiocIn. Tbe patient is noir entirely onvvloped in one 
half of the blankets, ami tbe attendant QnixbcK tbe operation hy 
pnHsiDg over to tbo rigbi side of t)io patient, and then procwding to 
tuck the left sides of the blanket nndor thu n|;lit Ntde pnciieljr 
in tlu) ■onto manner as we have aeen him tuck the right sides of the 
blanket Ql>der the left side of the patient. The attondant, staudinf 
OB the right aide of the patient's lega, finally insinuates his left hand 
under the }xu:iui of the aiiklru, lifts tliom np, and then with hie right 
hand tarns Inick tbe lower enda of iho bUnkets onder the hank." 
Tbe wet sheet should raach to tlie fuiklcs, and " be wide eoongh 
to ororlap in front of the Itody about eight or twelve inches ; over 
tbo wholo four or fire blnnkots placed, and prOMod down cluae to tbo 
odea." 

This pack is useful in specific feren and acnto inflammatorir 
disww. It has long been employed in scarlet foTcr, and shotUd 
bo naed from tbo Iteginning and tlironghont its course, lu moderate 
•tta^B it is sulIlDient to pack the patient from thirty to llfty 
minntoo ; but if the fever is rory high, if the nsh comes oot alowly, 
imperfectly, and of a dull colour, if the patient ia natlMS and wan. 
dering, the packing ranst be contiouoil an hour or longer, and be 
repeated tbneo or four times a day. Thin treatment <levelops tbo 
msb, greatly rednoes tlic fovor, q&iots the pulM>, renders the skin 
moist and comfortable, and abates tbe rcetlcosnan and wandering. 
A short time after the application of the wet sheet a patient, pre- 
viously reeUces and wandering, commonly falls into a qniet refresbing 
sleep, and awakes calm and free from delirium. It« inflaonco on tbe 
pulse and Icrapcratoru is irtriking ; tbo pulae in a few hours falUng 
fift<<iin to twenty beat« in tbe minnte ; a repetition of tiie packing 
greatly rodnoea tlie fercr. The ixicking is espeeially indieatcd oa 
sappresnon or receasion of tbe nsh. wlien sorioas aymptonis ore apt 
to arise ; tbe oold sheet will then bring out a brilliant rash, followed, 
gmerally. hy imawdiale improvement in the patient's oondition It 
has been rvoountii'mled to dash two or tbreo jiailfuU of oold water 
over the patient after eaoh packing. Daring iliu whole coarae of lbs 
fever a eold wot compTvas, renewed every thrao luiurs, shoaUl be 
worn ronnd the throat ; and if, on tbo dvcUne of the fever, tha 
toanls T«main laT;ge, or there is obronio Inflammation of tlw fauces 



OS rACKixo wmi raa mxt hdcet. 



h7 



¥ 



or larynx, tbiii ftpplicAtion, ranowcd Iokn frai^acDtlj, or applied cnljr 
at night, should be conlinuud till tbeeo morbid conditiona ooue. 
The comprcm xbnntd bo c-omposnd of linen Hoverol timM folded, and 
bsteaed ronnd the tliroat by another piece of folded dry linon. Cold 
paoking ia Iwniificiajly employed in other fcvrrit, iind in acuiu tuQuia- 
m&tioiM, M moalea, sm&U-pox, pneuuouiu, plenrisy, rhcamAtiinn, 
ftnd goni. 

In ocate rbeumatiam, when tbo pnin forbida Ibe patient to be 
movL>d, tltv front of the IkkIj only tibould bo pnvkpi), and ii wot cold 
oompnest renewed erpry two or tbrci' huura, Hboald be wrapped 
niiBd Moh of the p&infal joints. If ih^ prejodiccs of tbo pfLtiont'a 
frietuLt prereut tlio nw of tlie cold sheet, tlui body nbould be sponged 
with topid or cold water aerem] times a day. and if the porspirution 
is abnndaDt and funl, Koap Khould be nst-d. In uddiliou to spon^ng, 
the wet cold oomprcsti, aa previously described, sboald be applied to 
the padnftU joints. Thorc' out bo no qocrtion of the snperiority of 
Ihti treattDont over that of swathing tlie patient in finnnol clutlics, 
and covering bint in btunkots to make him sweat To avoid the 
sBppoKcd d&nger of catohin^ cold, these woollen clollics Arc worn 
day aft«r day, till, ntnrntpd with putrefying perspiration, Ibe stench 
sickens and dtsappetiies the patient^ lutd a crop of irritating miliary 
vcdclee in engendered, which breaks the patient's sloop. 

In pneamonia some pack the chest only, and nmew tlie cold appti- 
pJioalionfl honrly, or even oft«ner ; n mode of trcBtmcDt n'bi<^h is 
said to remove tlie pain, quiet the piiUe, calm the breathing, and ro- 
dace the fever. 

When, as ofi«n kuppcnd, tbo patient's friends object to tbe cold 
pK lc ing tbroogli fear of " inflamination," or of " turning tbo disease 
invranls,'' the sheet may be wrong out in t<'pid water, and by the 
timo it is si>read for the reoeption of the patient it will be snfficiently 
oooled to answer the {nirposc. 

A podeatriao, after great exertion, will find it an agreeable restor- 
ative, preventing sti^ces and aching of the mnsoles. to strip and 
wntp himself in a dripping wet cold sheet, well mbtung himself 
afterwards ; bat if stiSnoss still remains, a few drops of tinctnro of 
arnica taken internally will remove it. 

C!old or tepid packing is oscfol in the summer diarrhaia of 
ciiildieD. 



&B 



001.D IUTB8 IX rEV£SS. 



THE INFLCEXCE OF COLD BATUS IN FKVKRS. 

Tub eUbonito iavrntigntJODS ngnrding the action of cold itppl!«itii»u 
in fercrrs, made dnring the lul fifteen jrennt in Germ«iij, induce me 
to der(}t« a Mpurals cluptor to lliU important sabject. 

Tltctiu inrcatigifttionfl confirm the ctmclasions of Currie and Jack- 
eon, ou)(l give precision to onr knoirlodge coaceraing tbe oinplojr- 
ment nud cSects of cold to the •mrfiice. Tbia treutniont ba» been 
cmpIoTwl in Ij-pbnx. typhoid, and »cat-1et (oren, mciMlce, ftiwl nthve 
fobriio diamsee. More recently, Dr. Wil«on Fox and otbun have 
crnrvd pntiunt* iinifvring from the byporpyroxia occasionally oliBorvc<l 
in rheumatic foror, « condition, owiuff to ita sudden onitot and ntpid 
COOTH', hitUiTto r«gnrdi'd an nlmoRt nvcwenrity fatal. 

Many of the aymptocDs, and thervforo tbe dan(;en, of (crcn, de- 
pend in gmt mooBuro on the elavAlion of tbo teniporatnre. Tbo 
Hlonu of fever, whether specific or intUmmatory, on due eilbur to 
eloration of tbe tomperatore, to tbo specific canso of the forer, or to 
the inSanimation. The nyniptomii common to all feven ftre dne 
fliniply to tbo ctovslod t«mpeiatara of tbo body, whilst the chonctor- 
i«tic iiymptonui are duo either to tbo apeoiflc poison, or to the inflna- 
natioa. This inL'tvoso of tompcinture affects tbe organs in a two- 
fold manner ; in ibe first place, it perverts, depresaca, or, if th« risa 
is ri>r>' bi)fh, abolishes function ; and, in the second place, pn>dno«a 
fatty degeneration, or, as it is temied, parencbymatoos deguneralion 
of all the tissues. 

That tbo common symptoms of foTor, as headache, delirinm, qniclc 
palse, dry skin, and general wealtneaa, ore due to (be heightened tcm. 
INnrfOTO is well sliown by tbo affects of a treatment wbiob will 're- 
duce this abnormal tempersturo ; that iji, by tbe aid of tliii oold 
bath or qntnia wo lower the tompcmtura to tbo normal standard, and 
then those pyrcxial symptoms at ouoe disappear. 

Fatty de^netation of tbe tissues Bot« in during tlio pro^'reas of 
a ferer, atpeoially when proloonred. This degenemtion bai boon 
ol>served more particutarly and fnlly in tlie livor, kidneys, lioart, 
blood-rossols, and voluntary muscles. This fatty doftvnonttion is in 
all piobabiUty due to tbe feror, for the degree and extent of tiM 
ehangas oorTO])On<l in amount to tbe degree and dnmlion of the 
elevation of tem|)emture ; and similar changes ocoar when tbe tent- 
poratani of an animal is nised by keeping it in a wartu ebaniber. 
The cells of the liver and kidneys become cloudy, tbon Krannlor, till 
the nnclens booomsc obscured, and the entire cell distended with 
grannlca. and, in the csnu of the liver, tbo ccIIh ciintaiii an exooas of 
(at, and nltimatelj many oolla bant and jwrish. Tbe mnaook 



COLD BATBB IS FEVEBS. 



59 



^ 



of tli« beart ftnd of (lie Tolun(iU7'')niiscleB becomoe groDnlnr, tbcn 
fattv, and in aovero ciisos their librei nndergo ext»u>iva deatraotion. 

ThMe offeeta of b%1i teuiperature, the ^rmptoms isd t1i<^ dotorio- 
nUio^ changies. can obviouKlj- Ixi oombated only bj moeDA tvhiuh 
(litbur Ii>w«r ur prevent tbe nndae dovelopnmnt of body-beat, 
i'omnosl amongst theeo laeAtu mast runic culd bntba. Kmptojrcd 
early unougb, ttioj obviate tbe immediate depressing effect of tbe 
tempenture on the tiMuao, nnd prevent the oncoming of pftraichy 
niBtotiii degeneration. Tltna tbey reducv tbe frequency of the pnlset 
Bti«ngtlien the heart, and so »rort danger from fnilure of tbo boart, 
and from byporttntiu oun^^tion. Tbuy tend likowiso to prevent 
delirinni, and to produce soon d [and refr(«liin(c sleep; to improve 
digcdtion nnd tuMimilation, and to promote the goooral nutrition of 
tbe body, and thuo to nvrd off or to lessen tbo risk of bod-sores and 
oxbnttKting' imppDnilion. The period of convaleacenoe, though Mme 
deny tbia, is shortened by promoting assimilation, and thus prevent. 
■ng parvnobymatouK degcaenttion. It la trae tbat tbe ajiedfic 
poiaen of some fevers, as typhoid or typbns, will itself probably in 
sono degroo affect the liearl, braJu, and fnnctionN generally ; but that 
tbft depression of the heart anil brain is mainly dne to tfaa elevated 
tempomtnro is sliown by tbo grunt abatement of the ajrmptoms 
referable to these organs irhen the temiverntuN is reduced ; tbougji, 
indeed, it may bo pbLtudbly urged that without elevation of teinper- 
aturo tbe specifia poison cannot be formed, and Iiutioe anti-pyrotio 
treatment will Ultowiao obvaato ita depressing efFects. 

Cold batbinj^ is applied in ranous ways, by monns of tbo gcneml 
cold butb, affuxion, piicking, spongiog, and by the use of ice. 

Btand, to vrliom tbe revival of this hydropatbiu trpatmcnt is chin.lty 
dne, baa employed it largely in typboid fever. lu mild cases be 
OHt cold wet compreaeeB, or frequent vrasbing with cold water, or 
repeated |iacldugs in n cold wet ebeot, or a warm balb gradually 
oookd. lu severfl casea he reoomtneudi aSuaion, tho shower-bntb, 
or tho general cold bath. Ho generally places the patient in a sitx- 
halh, and ponni water of 50' to 55* Fab. over bis hond and slioublcrs, 
for ten or fifteen minutes, wraps him afterwards unwiped in a ebeet> 
Mkd covers him over with a coverlet, and to bin chest and stomach 
applies compreoaes wrung out of iced wat«r ; but if tbe patient com- 
plains of tbo cold be covers the feet mora warmly or appliea hot 
battles to them. 

Ba^^baob employs a general cold bath of GB* to 77° FaJi. for ten 
or twenty minntev, and if tbero is mnob delirinm, or coma, be at tbe 
■aOM) timo pours oold water over the patient's bead. He disapprovos 
tbo frequent cold wash ings and pockingit, nmcirting that they abstract 
but little beat and that they fatigue the patient. 



60 



COLD DAT8S IK rKTIU. 



Tlio method emplojred hy Ziemssen and Immerman n tbo most 
•gTMAblo to titu patient, nuil boing <!qiinll_v (i&icitmt, it in tbc treal- 
nent moet likety to bo generaUy adopted. Thej immene » patient 
ja • bath of 95*, and in tho ctonno of twenty to tbirty minutes gf»- 
AaaSj cool it to CO' Fah. by the addition of cold wat«r, This both is 
ftgreeablo to fomr pntinitD. Tht'Ho obwrrLTii do not employ oSasioD, 
since tbe patient much dislikes it, nor cold compranevt since thc>se 
do not affoct tbe roctAl tompcratnrc. dild packings ibcy find, bow. 
tnr, do rodnc« the Unnporntnra oi the rectum. Fop yonng obildran 
and old persons tHo sorvrity of tho nppHcsitioii most be apportioned 
to the 8tl«iiffth of tJie patient. Brand wmpfl a child in a wet sheet. 
nod plaoLR^ it on a table pours ootd water »top its bosd. For chil- 
dren and tho Rf;vd Ua^enbaoh employs for half an hour a warm 
bath, gnulnally cooled by tlio addition nt cold water to 86* or 7S* 
Fah. Wwkly pntienta shoold be well rubbe<l on leaviag the bath. 
UnKoiibach aJdopta this trmtmcnt whenrver the tompemtnro rises 
nbovo 102' Pab.. wbile Brand recommends it whenever the tempcr- 
atare monnte abovo 10!{' Fnh. 

In privato pntvlice I find the nssidnous application of cold elotbs 
wrung out of ice-cold water mora coDveniont ihnn the use of tba 
gmcrsl cold bath. Thi* plan, if offeotiuUly cnrritiit out, pnimplly 
redticea the temperature. Tbns, bj tho method I nm about to 
dMOribc, I haro Hcen the tcmpemturet in byporpymxia reduced ii 
two or three hours from 107* to 101*, or even lower. 

Dip four napkina, or Rtnall towetn, into iced wnti-r, and wring them 
neariy dry, so lliat thej' may not drip and wet the bod, then apply 
then OQO biitow th(i other from tbo chest downwanls. As soon us 
tho four cloths are disposed over tbe cheat and abdomen, re-dip and 
TV-wring the upiN'rmost, then the woond, third, and fourth, neriatim, 
tbea the Ant SFruin. and so on continuoaslj. Snppli-nieotury napkins 
to Ibo bead, tkighs, aod amiH will of oonrse still more quickly lower 
tlte tenipenttue ; and, indeed, should be employed to a btf; and stoat 
patient, since large qnantilics of heat have to bo withdrawn Ihroogh 
the bad conduciinit fatty Inyt-r beneath tho hIuu. If tho iiajtkins 
am inoesMnUy changed, this method is moat aBloacions. and is often 
highly agreeable to the pationt, beii^ in tkiii respect mperior to tbe 
froneral oold bath, which is usually vevy diaagrecable. 

Tlie repetitionof the prooittsda must be regulated by ibo •ubsoqaaat 
ootirae of tho fever. If ta thr«<e or four hoars the temperalnre agafn 
rises to 103°, Itmnd re|iuils the aOnsioo. In most caaes ho findii that 
■ix nSnsions are eooagh, and aftcrnarda he applies cold cloths wn-ng 
out of wator at 60^ Fall, two or three timsa a diiy ; litam appli- 
oatloBS, provided the temperature does not rise Inirhcr than 100^ Pah-, 
boiif aisda smaller and ^pliod 1ms froqnantly as tbe oaaopiogrBHH. 



COLD BATBfl IS FETBBS. 



GI 



In Tuy SBTOTO Clues tho affasion mojtt be employed crerj two liouro. 
Wlien this [MtLent ia ooiuktoee and Uk foregoiog troalment fnib to 
roitoro oonBcioameae, Brniid kpplivR a cotd affiution ot 4h' Fob. to 
the head tmry balf-luittr. 

Dr. StShr recommends the contiDoance of thin trotmont in 
Q^hoid term to tbo middlu of the lUtrd week ; bat it maj bo r«> 
qnired loogsr, and bora tbe thermomoter ia tb« test. 

Ziemnen and Immiermaii Und thai witli their plao four or five 
bath* aronooMmiy tbofirslda^, and tliat xnbacqiienUy two or throe 
daily will auflloe, thu reputitiuu, however, being regutati>d by thu 
informntion afforded by the tbormomotor. Tbey proscribe the batb 
at G A.u., and 1 to 3 p.m., and at 7 r.M. Zioinasen oud Imincrinan 
found, a« might bti oxpoctod. that in ty]>hoid the degroe of cooling; 
and ite dtinttiou diSersd oceordinK to ihu patient's af^e. and thi; 
aevcrity of tho cneo. Tbos tboy find tbe usual rpilaction i» 30' Fah. 
ID ehildren, and 2'6' Pah. in udultii. In severe adult caaex, bow- 
mar, tbe trmpcnitTiro fatia only IS" Fnh,, and tlu: dfcct of tho bath 
is least evident in oasea where the tnorning remiftaiou ia ^liRkt. In 
floverc ia^tila casoa th«y found that tho tomperatnro rocorors ita 
former bei||[bt in nix hours, lu adult eaxuK of moderate Noverity in 
•even honrsi and in aovvre adult caeca in six honra and a half, and in 
CMea vitb alif(bt momlng rcmiauon:! in tbrev bour-i. 

A singte bath oftan affects a considerabta roduction of the febrile 
temperature. Thas Uasler reduoes tbe temperature in a rruw of 
typhoid U> 7" Pah., and Dr. Wilson Fox, in ono of hia interesting 
cases of rbcumatio hyperpyrexia, l'i!'4' Pikb. 

Dr. Wilaon Fox's exact and continuoae observations on some caaeR 
of rlMumatiD hyperjiyroxia add prei^iaiou to our knowledKi-- of tbi^ 
affaoto of cold baths. He has shown that the fall of tompcratun^ 
oontinoea every six or more degrees, forty or fifty minutes after the 
disoontinnanoo of tbo bath. It is important, therefore, to obMrve 
the temperature iu tbe reotum while tbe patient is in the bath, and 
to rotnoTo him before tho heat is too for rcdnood, Icet too great a 
withilruwal of it might lead to collapse. This indeed appeara 
eometimos to occor, for wv road uf caees becoming cyanotic, althoa^ 
German oliservoni aver that this is not important, and advise in mcli 
a case the application of warm bottles to tbe extremitioe. Still 1 am 
oonvinoud that it in iiupurlnnt tu avoid depressing lo thia bitKarduas 
extent, aa I have scon a uliild, sufteriiig from scarlet fever, lulled by 
an over-encrgette empluynteut of cold. 

German observers show conclnsivcly that tliis treatment grealJy 
radaoes tlw mortality of tyiJiuN »nil typhoid (cvkt. Than Brand 
tmtad 17U casiM of lypbns, and Bartela treated thirty cases of 
typhoid without i> single death. The mortality of Hagunbaoh's 



®s 



COLD BITES tK IHTEKS. 



typhus pBttraU WM fiTA pei- oenU, provided tlio omoi wen timt 
«nrlf , bikI Dr. Stijhr redacod tho mortnlitj of bis pat!«nU from tliirtj- 
to ftix per cont., and tho resolte he thinks would haru biwn ittill more 
fftToamMo could he bavo Irt^ted wmH of hia cafi« oarli^T. Liuber. 
muiatcr lessened bis inortnti^ from tvteatj-wtma to eigbt per cent 

Notwithstanding tbo eutlinoiaatio landaLiou of Ui9 <!old<bnth trotU 
mcui ol fevers by German writors, ibis plan has found bat sirnnt 
favour in tbiH country. If tlieni is rcMson to hesitate whctbor wo 
should treat tbu ucuUi tpcoUic fevers or infljtmniiitorT fevor bjr Ibia 
heroic molbod, there eta be no qn<»tion rospeodng its i^rent vaino i» 
tile treatment of byporp]rr«x]a. This most dangerouM condition 
Keuerally arises from rfaeumatJo fcror, and to it, no dotibt. moat of tlio 
fatal cns(!( of rbouraatismaroattribntabte. It may occur, bonrcver, iaj 
tJie course of any fever; and may, indead, aeiEO a jterson apparentlj 
in perfcpt health. Tho 6rst case of hyperpyrexia OTcr noonle 
oocorred wInUi 1 was resident oflitor ikt Univetaity CoUoffe Hoapital,^ 
and iKis was an instance of a sudden attack in a woman wlio hod 
reoo\'ered from rhemnatio fever, and was on the point of leaving tlwj 
hoapttal apparently in &ur hoaltJi. On being called to her uvi* 
I was surprised at the pnoifent bumiutc beat of her skin, and to mj 
aatonishment fonntl her temperature to be 11(1°, and a little btovj 
111°. She died in ei([ht heura. This phenomenon, so starUtng the 
whoo hyperpyrexia wm unhntrd of, Iins l>een noticed in bundred* of 
otaea. Hyperpyrexia not unoomntonly attacks ohildrcu just provi- 
ondy in apparent good health, 1 have often sean children in sevo 
oonrnlsaons, and have found their rectal temperature 107° und 1( 
Fab. Tbe hyperpyrexia may bavo been due to tbo onset of an aont 
■peeiAc tevi^r or of an acute inflainraation, but aa Uieao children all 
died it was impossible to asc«rtain tli« cwiae of the onset of the fat 
hyperpyrexia. Ordinarily, no donht, hyperpyrexia occnn in thi 
cmirse of a fervr, and goaemlly, perhaps, when the tempcratare ran 
very h'mb ; hut this by no mcwui rarely oomea on in rhenmattc fa 
when tha fever is niodcnite and the symptoms mild. In a typical' 
CMW of hyperpyrexia tbe tcmper^tare rapidly riaea, reaching in tbe 
eotliM of a few honrs 110°, 112^ or even higher. This sorere fever 
pertnrbs and deprusMS tbe functions. At fint the patient is restlras 
and delirioua; tbo deliriam being either alight or so decided tbnt hr 
mnat be rotrainnd. Sometintaa before delirinm the patient bcooBiM 
bluid. Tbe deliriom soon mibsides, he l>ecomc« quite uooonMbmat 
tlie jiulse, at first full and bonmlin;;, Iwoomea exceedingly frminvnt 
and fvelde ; llie rH[iiratieoa are mech hurried ; the skin is genniully • 
dry ; but it may tw drenched fn sweat. Then tho oomn deepen*, 
bmthlBg bocomw more tminenl and sballow, and in a few bonra i 
paUvBt die*. Not a itngle case of by[ Nwy j mxi a, na f ar a« t 



COLB BATBB IX nTEIIS. 



G3 



BfiitoBd till Dr. Wilaon Fox firal treated hia casieit witli tliocold 
BHUl Siuco tki^ii thU trcfttmont luM bcon ln.Tgcl<r employed, nud vritli 
^klarger meaeuro of succais ; indeed, it is not aa exag^iatioa to aajr 
tliAt the uiajciritj' of th« cum tbaa trontod Imvc baen eftred. In my 
own practice, !n a caasidera1>le nambeF of cases, tlib IrQatmeot ban 
genenHy pro%-c(i MtiROGmfnl ; nnd it ii; a sonrcc of great gratiSoation 
to itw tbac bj meaos of Dr. Fox's treatment I have oertainljr i«v«d 
tDMnj livoK. In hospital we mainly nse tbo general cold bath, but in 
privnto practice tlie apjdicntifin of iced uold elotlis in the wa^ pre- 
▼ionalf deaoribod mil, I believe, prove more coaveoioDt, plmuant, and 
Btife. Several cold baths aro naunlly neeCMilrf , for after tbc redac- 
tion of the tcmponitQnj, and consnqucnt removal of the gj-tnptoms, 
tke temperature generally riatw again. It is iuterestiog lo note tbo 
pUiiing Awaj: of the deadly symploms as tlio tomporatQro falls. The 
pAtient wakesontof hia coma, and next his inind hecomuaqaite clear; 
hia palse falls and becomcG strongvr, and ho poMca qniokly from most 
imminent peril, from the very shadow of death to hia condition 
pnviona lo the onklanght of tho hyperpyrexia. Though 1 liavo itaid 
nvcnU cold baths are geoeraJly needed oompletely to suhdae the 
hyperpyrexia, yet in three emeu nftiir the first redaction of tliv 
tomporataro the hyperpyrexia did not return, bnt the patients forth- 
with passed ut onco from a condition of urgent danger into conra- 
lo8C«DCG>, without nndergoing a single nnfnvonmbte symptom. 

This treatment not only reducus the cxucMsivo heat of fever, but it 
^lay* tho nervous symptoms, limits the wasting, and Brand says it 
alio prerenta metvoriitm, bleeding, and lesKms diurrhoia in typhoid. 
On tha other hand, Uageobach and Jurgensen assert that this treat- 
ment fails lo leaaen tbo motooriam and diarrhoo in typhoid fcror, and 
to reduce the siie of the spleen and the dicrotiam of the pulse. All 
obfiervere agreo that cold batlia do not shorten tlic course of typhoid, 
tophus, and other acute specific fevera, but Brand asserts, while 
Usgenhach deoioa that thoy shorten tho stage of convalesoenae. 

This treatment, it is aaid, rarely, if ever, induces either brouchitia 
or pneumonia, and tha cn-cxistvneu of either with a fever does not 
contni-tndio-ato the use of cold baths. Liebermeiater even saya that 
hypostatic congestion or pneumonia afford no reason for suspending 
the baths— that* indeed, under their use, hypoatatio pneumonia some- 
times disappears. I bnve wvcrnl times seen all the signs of doable 
pneumonia arise aftur tho bath ; for in»lAncc, duloeas, tubalor breath- 
ing, bronchophony, and yet thi;«c patienta have done well. 

Lvdwig and Schroder find that this treatment of fevers greatly re- 
dnoea tJie quaDlily of carbonio acid exhaled hy the lung* and tho 
solid oonstituonts of the uriue. and thus lessens the lissne change ; 
a very aingnlar fact, since cold baCh», in health, havo tho very oppo- 



M 



WARN BATH ASD TBW HOT BATH. 



Bite offset. Dr. Pox olwirireii that aometimca tlia recUl temperature 
rinuH* little directly tliopalii^ntiKplnood to thobath; and Dr. PiodJvr 
and Hftrtotutoin point out tbut immediateljr after the bath tbeudUarj 
is mnch lower tlutn tlie nctai t«inpor»tare, but LiUt an boar After- 
words tbiB discTDpftooj iit rcrened, Uie rectid bempentnre beeuuiing 
from 1° to 2° Fah. lower tban tb* aiillor;, asd ao coittiBtuDg during 
three-qnarterH of an boar. 



THE WARM BATH AND THE HOT BATH. 

Tm offoctc of htnt on tb« bo<Iy are, of ooumo, for tbe most part, the 
opposite of cold. By aurronnding tJio body with a tempenitare 
higher tJian ita own, tln! d<TstrDotion of tbe tiasncA by oxidation 
ia GODuderably diminished. Morooror, oxporimcnt btw slinwn tliat 
incn»sed beat impede* or destroys the electric ODTTenuin tbe nervu, 
wbeooe it may be fairly presumed tltnt when snbjocted to thi* inADcnee 
they are less iU>lo to oondact improssioDs citber to or from the brain. 
TbcHe (wo confiideratii)iu( may perhaps occoont for the onfeoblinft 
infitionec on the l>ody. 

9'Ae fmeral ttmrm bath, if not too hot, is at Grst highly plonmmblo, 
but if Bndaly indnlged in. tJirobbieg at the heart and in tbe largB 
vesseU aooD oome« on, with beating in (he head, and a twtise of opf>rM- 
aiun and anxiety. These aensatiotui, howuvcr, when per* pi rati on 
breaks oat, greatly diminish or altogether coaso; but if Iho Intli is 
oontinned too long, the foregoing nnooiafoTtable acniations retnra, 
aooompaaiod by gre«t prastmtion, oven to the extent of fainting ; the 
polae beoomes grmtly qaiokeDed and enfeeUed, while the tem|wralar» 
of the body rises very c»aiiid<!r»bly, and, if the heat of the bath is 
gre«t, may oven reach 10t° Fab., lh»t is, to a aerere fever height. 

Warm baths are employed in Bright's disease to increaen the pei^ 
tpiration, so as to Iccson the dropey, and cArry off from the blood any 
delsterious matter rataiocd iu it through the inaction of the kidiaeya. 

We mast always bear in mind tbe purpOHC of the hot bath. It is 
toe maob the pmcticu to employ hot baths ia Bright's disooso before 
the oocurrenoo either of dropsy or Biwrnia. As the baths weaken tlw 
patient considcmbly, they incrcatw nmcmia and so favour dropsy. 
They should only be employed when dropsy or urs'Uiic symptoms are 
marked. Then, no doubt, they are often TOiy Mrviccable liy remoriiig 
a large qmmtily of water from Uie blood, and lessoning the bydrwmia 
on whioh the dropsy dujwnds ; bat whilst of undoubted serviee, if 
often rniu'Dled, they induce mnoh weoknnet. In my experience baths 
w* greatly inferior to the plan of making incisions over oaoli exiemal 



I 

I 



WASH CITH AXD TBE BOT BATH. 



6S 



maUeoltu in tbe w&y doscriboii in the secUon on Mapnnoture. This 
trefttmant rodaces th« dropsy tnaoh more spncdilj', and far inon» 
certainly. Horeovor, tho nrott diaolvod, in tho dropsicnl eSiuion 
dmw§ uvay inst«ad of beinj^ roabftorbed into the circol&tion. 

The hot bath U aIko need in aratnia vrith the view of Dlimin&ting 
the nrm ihroogb the «kin. Tberu i-nn bo little doubt that tbia 
Iroatmunt in aorricoablo in romoring a»ny of the cerebral mani' 
fwtationa of urtemia ; but it is ruiy (|noHti(mnb1i; wbothor tbo butba 
M act by olirainiktinp tinta. It i», at best, doubtful whether the 
nrvmic ayniptomd dopend on tbo rctcmtion of nrcit in tbo btood ; 
morooTor, it ie uncertain to w)iat extent, tf auj, the bath can eliminate 
nitrogeDoaa ])roducts tlirougb tbi- Kkin. It is crrtain thnt in health 
Tory little, if nay, urea <w»peB bj the skiu, though it is probable 
that in some cases of BriKht'ii diRMtiin area is actually itcpntutod with 
tho pcrspirvtion. BartoU rocordj cases where cnstata of urea 
covered the face, and by tboir accnmulation on tbo beard gnvo it a 
froftad appoaranco. 

The fceneral warm bath ih of ni^nl service cithiir in aimplc! or 
ioflaiainatoiy fbvcr of children. If n child is not very weak, a bath 
night and morning, for a time varyini; from five to ten niinntes, 
eootbca and qniots, and often bringn on rofrcshing sleep. Tn the 
febrile diaeaww of ^rowii-u[) people, it la gL-iiendly difficult to 
ORiploy tbo general wnrm Imth, but, in its Etcad, nponging with 
hot water o(t«i induces perspiration, calming at thu aamu time 
tho rrstltaaneSB of tbo patient, and bivouring sloop. The samo 
inc«na will soothe the reetlet«neKs of canTa)escieDC« and inilttce 
sleep. 

The warm hath mitigates or mnoriiK the pain of colic, renal, 
biliary, or otherwise. Whetlier its effects in relaxing spaBni are 
induced through its soothing influence on the skin, or from wcnJcncas 
oaaaed by the bath, is diOicolt to say; tho batb certainly seems to 
0BM tbo pain lirforu any noticeable weakness in produc^l. In skin 
diseaaeB of various kinds the general wnmi hnth is inrnluabte. In 
paonaais, ecisnia, ictbyosis, urticaria, lii-hi-n, prurigo, and scabies, it 
may generally be employed with benefit. It in rspocially useful in 
tLe «CDt« slate of eczema and psoriaais. Rain or boiled water 
•bontd be used ; hat if those ara not available, the water should ho 
nade more soothing by tbo addition of small pieces of cnmmon 
washing soda, gelatin, bran, or potato^tarch. These baths allay 
inSammation and itching. The liody muxt be dabbed dry with soft 
towels. If there is much itching. Hannel ahonld not Iw worn, and 
scratching efaonld bo prohibited. 

U bos been recommended to keep ([niot a patient withsovoro bums 
iuBieraed for days in tho warm bath : this treaunent is said to ease 



6C 



ffARH BATH AX» THE HOT BATH. 



pain, dimmisb auppumiiori, promoto tha Itealing process, anil to 
leneD tlio conlrnfitioii of the cinitrix. 

lAgonbnck uuwrU, thnt coottnuoiu immorsioQ of tha ttump iu 
irann water nft«r an amputation will arert pjneuia. 

Aa a mouia of oliviuting tli« vatjoim symptous ORonrrin^ si thn 
citMiifie of life. Dr. Tilt reoommendt the ijeneral ironn b«th of W 
to 9Sf Fab. fvT an boor oooo a wd«Ic, so m to promoto frM perspira- 
tion. 

Tbabot sitz.bath is verjr mofttl in cj'stitis and dysmenorrlicca. II 
atlayH jmin and tlie iDceaaant desire to mtctanle and trtntining. If 
the ejtnptoms are argent it nay bo employed two or throo litoos n 
day fur twenty to thirty miuDtoH in cystitis, aiid ovtra longer in 
dyaiDonorriiom. 

The local ininn bstb >a need for a rorioly of pnrpowa. It U 
hardly neotssary tn rvinr to tho common buuBoliold practice of 
putting the feet into lu>t water jti«t befoiv going bo bed, to iadoM 
general perspiratimi, and so rvlivvo ontarrfa. Tk« liot fooUfaath. or 
tbn sttx-bntli, is of gnmt scrvit-e when tbo mcnstmal How i« oitber 
deficient or absent. To this bath, mustanl may bo added with 
ivd\-anUig<i : bat, aa tJw late Dr. Oraves inMiotod, this stimolatillf 
batli fhonld bo aged only at tbo inonstrual period. Employed 
nightly, or night and mominif. for six days, commencing one or two 
days beforo tho period begins, lliis dastard bath is a very useful 
feoxiliary to other treatment, and oEtan aoccoods in nitahlishiuft 
nenstraation. The Bla-tath ia often dEectoal when, through «x- 
posnr* to coldt or &om oUier oinmnatanoa, the m<'0Htru»l flow is 
suddenly atopped, to the pntjent's grml annoyanoo and vuttmajf, 
Immvrsion in wattr as hot as can be botne is said to bo vn^' uacfnl 
for Nfmurtii, in thoir earliest stage. 

I>r, Dniiti pointN ont that aponging tlw body with vvry hot wator 
will for Kume honn diminish the exoessire perspiration of phthisis. 

U(i( wator for the legs and [c«t HOmotimM rcntovos liowlaoboi and 
Booording to Ur. Gram reliovca diatrwing pgUpitotion. 

Sponging ifae fnoa, temples, and neck with water, as hot as aw be 
borne, ofton relieves the Iwadaohe of inflaenaa, catarrh, and otber 
dboases. 

The Anl'tfir bath vary gvaerally aucoeods in prumutiiig free ptwnpin- 
tioa. If it is difficiitl thus to eslabliali a free (low i>f ]>i'ntpinition, 
tlie bot>air Inth may tie prooadod by tbo gnnand wann balh. 

Vnponr- bathe ore nsed for tbe esme pnrpoae, and are less dopr 
tliaii tbe general warm bUh. They produce much toss elevation 
lite t«mporalan of the body, a oircumsteiwe which probably ex| 
tbeir difloiMW in this respect. 



BR01rBI^ DOUCSB, ASD STOKOK SATR8. 



67 



k 



SHOWER, DOnCHK, AND SPONGE BATHS, 

The forcible impnot of wat«r opon tbo body, and the improBaion it 
mnkes oa the norrM, or, to use Uiu general ex|)r«Mion, Ibe sbock it 
pToducM, is Mmotimos Torf gront, otifScietit sometiinea, even with 
•tfonfc and bealtby persons, to prodttoe considerable depreMiun and 
lanpior, lasting boars and occauoaallj' days. 

The nbower-batli ia a remedy not much lued, patients ordiDarily 
nuinifcstin^ gncnt mpiignanoo to it. Tbo i>pongo-b»tb, or tba local 
doaobe, may uBofolly supply its place. 

In th« sponge-lmth wo linre all tho conditions of the common 
bath. Botli are oleanaing, bracing and inv^omting ; and UiD notion 
of vacb is tdnttioal. 

Tbe apongv-batli is often employud, not merely for it« tonic cifoctfl, 
bnl on accoant of tbe ehock it cansee to tlie nervous system. 

In tbe treatment of Inryngismiu stridnlus, cold sponging ie moru 
BBOoea^nl tban anytbing^ else. Tbe praoticc of oouliuiui; liillo ohil* 
dren tbm affMrtvd in a warm close room, sousing tfavm in wann baths 
■everal times a day, is positively injnriom, and inevitably aggiavatee 
tba acrority and freqncncy of tbe crowing breathing. Cold sponging 
tirioe w tbrioe daily, according to tbe severity of tbe nuf, will 
scarcely ever fail to moilify tbe disease, howevar severv tbo attack. 
So prompt ia tbe relief of cold sponging tbat a obild subject to 
bonrly nttaclcs daring the day, and to ceaseless attacks at night, is 
fieqaently in^tantaneoasly deiiventd from tboin. At all uvents a 
decided improvement always occdfb, and tho inten-als bctwoon the 
attacks arc much prolunged ; it rarely bapj)etui tbat the strident 
crowing resists this treatment more than two or three days. The 
notbev should be directed to keep the child out of doors the greater 
part of tbe day, no nintttir how cold tho woatbor^-indeed the colder 
tlie better. Laryngismus seldom attacks okildrcn more thiui n ymr 
old. At 80 tender an ago it might be fiearod that tbey wonld mn 
great danger of catching cold from tbe sponging treatment ; hut no 
nch fonra need bo entertained. With tho necessary precantiona, 
even tbe youngest child may be sponged with }>i'rfuct tafsty anveml 
tiroes a day. Nordoes a child catch cold even in tbe coldest wMtber 
whon carried out oC doors; but uno prone to bronchitis had better 
bo kept indoors when the weather is very severe, and should undergo 
tlte cold>wutor sponging only. After a very vxtcmdve experience of 
this treatment I have rarely found that children soffering from 
laryiigismns catch cold, and in snch exceptional cbms tho catorrlud 
symptoms have been insigniflcnnt. This treatment freqaently eaves 
life, and avcrta not only tbo crowing breathing, but dangerous symp* 

r 2 



08 



BBOWEB, COCCBS, ASD EFOXGK BATHS. 



toms, sncfa as pnrtial CDnvnlaiona in the fonn of cnrpoped*] oontrac- 
tinnii nnd iqainlinfr. fur larvtiginmas, wlica fatnl, gcDonillj ilcHtroj'ii 
bj exciting an ntlaclc of general convulaioni. Larynpfismas Btridnlos 
in wcDetimes ncoorapaninl, and t* indcvd nppar«ntly induced, b; 
larTDgitih indicated hj tlie peculiar hoaree voice. In Booh CMSs 
oold iponginf; ramt be cantiouiily nwd, for it often, though bj no 
meona iDvonablj, incrouoa the luyngitia. and therafore the Inrjn- 
ginnnit. Among tho poorer cI&mm, at certain mufonti of tbo yi.'or, 
larfngi&mns la odo of the most common oavMi of coorulsions, 
which tend no often to a fatHl lasuc. 

The sonst and spccdictt <nj of arresting a parozynm of crowing 
InMitbiDg i* to dash cold water over the child. At tho on«et of a 
paroxysm cold water shonld he dashed on the child's face ; and if this 
(loCK not at DDce arroat the nttAck, water shoald be applied to the 
whole body. lAryBgwmna fortunately preraila in the early spring, 
when tlie cold weather itaelf is a rcMly oonroo of onre. 

Since by this treatment laryngismus is usnally ouied at onoe, or 
nutij lasts more than a few dikya, it is obvions that cold water docs 
sot set as & mere tonici although iu this respect it is very osefnl, 
beoanso laryngtmnns generally attacks weakly, sickly and rickety 
children. 

Any irritation aggruratce laryngismus, and imprdcs it* euro. 
HenoO) if the relief bom cold sponging is less marked than might 
be expoetod, aome other aonrce of irritation should bo songht for and 
removed. The gams if swollen, red and hot, must be freely laneed 
and tho cat maintaiited open, for if they dose tiio irritation roours; 
tliDS il is necessary to tanoe the gnma ertry few days. Worms 
most bo n-movvd, and the faulty slate of tlie mncons mem)«ano 
favouring their production treated. At the cntLing of each tooth, 
laryngismna ia apt to rocnr in spile of oold sponging, bnt the rekpaa 
is seldom severe. When tite tension of the gnma is removed, and 
tho tooth sot frw, the fit c«nm». Irregnlarilies of the bowols, 
dinrrhcra, constipation, llatnlence, &«., tend toinorea4ie tbe freqaeacj 
of crowing, and to rvnder the case less amenable to coltl xponging. 

It may hero bo useful to advert to a condition, not uncommon in 
infants. An infant in poor hcolth frequently wakes up at night 
from " a catch in tlio breath." From some unezploiDcd reason, it 
oonnot for a time got its bcvntb. and wakea up with a liiad bdoio. 
This condition is 'altogether diffriont from that of laryngismus 
stridulus, and the fanit a|>peani lo lie in tho soft palatt,', not in tiin 
htryni ; nvorsover it ia tio4 due to enlarged tonsils, as this ''catch in 
the breath " oocurs in children of tender ago, long befniv tlie raorbid 
oondition of the tonsils takes place. Cold sponging, night aad 
■Doming, will improve or even oBi« tbis eurioM complaint. 



I 

J 



BMcnnK, DOOCBE, jLid) SMicaE bitbs. 



69 



Cold epon^ng, Hovvral timuit n day, holdH also dcserTedlj a rery 
high place iu the treatment of cboron. It ix at prptwot impossiblo to 
decide whether its cflicucj' in duo Hulel}' to its tonic pro pert iuN, or 
whether tlifl ahuck ])la_v8 nny pnrt in ]>ratii()ting: llio nun. Of the 
v&luo of iHis tivnlmunt thi-n- is tio <|uestiau, yot circumiipcotion must 
he cien-'ised or llie (ULtient mny br diimIi: worn;. It muBt be avoidnl 
if th«ra is ftnj rhunmatiMO, which i§ gpticially made worm bjr cold 
epon^n^. thiw inducing »n incrwwn of (tligranc moTcmcatfl. If there 
ifl no fover, and no jiaiii in itn)' of the joiute, then ootd spoDging mnjr 
be muonftbly vxpcuted to yield most ratiafactorx results. 

In the treatment of riukctn, cold Bpooging, by virtue of it« tonic 
properties, holilM a very high ploco. Horn, ugnin, care muHt bo 
obaerred, or much harm m^y be done. We moat remembor that S 
rickety child in often not only very wenJc, bnt, on account of ita 
tender yean, very imprmiuonnhle, and for theto reaeona it i.i 
imjMrtant to adapt the uppUcation of the cold sponging to tbo 
patient's condition. If tho child is old enough to Btand, he shonld 
bo placttd up to the aokleA in warm water before a good Urc, and 
th«n, except the hood and face, bo ipongcd all orcr with cold water 
from two to fivo minntea ; he should then be carefully wiped dry, 
and well rubbed with a soft towol. If weakly, tho child may tw 
rvphMMid for a xhort time in a warm bod, to eaconraf[« reaction. 'I^q 
apongtDg should be administ«rod as soon aa tho child leaven bin bud ; 
but if very weak or nnat-'cnttomed to sponging, it is advisable to givu 
a light and early breakfast about an hour beforehand. Then; iw 
another cxccll<!nt otcthod of admiuiatering odd sponging to weak 
persons or to timid children, and thcrcforo a plan to be adopted when 
this agent is nted in the treatment of chore*. The water at lirst tepid, 
should bo gradually rodn<ro<l in temporatnrD by drawing oIT thrt warm 
watvr and suhMtitnling cold. The idiock is thaa avoided, wLilst the 
Ionic virtue of the bath is obtained. This latter method imcceeds 
admirably with timid children, who, often much frightened by the 
bathing, sometimes scream so violently as to lead tJieir frieudM to fuar 
an attack of oonmtsions. 

Cold ponging is very tDvigonvting for jidults in impnired health ; 
■t is useful also in annroia, leucorrhcuo, amenorrhaa, npcnnnton-hcoa, 
and in that low nervous state induced by working in hut, cIuhc, 
ill- ventilated rconut. 

In cold weather, tbo water at firgt shonld bo mode a little warm, 
afterwards the temperature should be daily lowered. Tho deprcMing 
(ffecta on tho weak may gcnorally he prevented by a little light food 
taken nboat an hoar before the bath, and after its completion by a 
ntarB to bod for half an hour to restore nurmth to tho skin and 
txtnmitiea. 



70 



RBOmS, POUCBB, AHO 8F0MGB UTH8. 



Jffiifion an4 the Douche. — Cold imter titns apj^ied unpin^tu OD 
the hady with oonsidemble forco. and Uw TMolting nervous itnpn)»- ] 
Bion iM corn)«|K>Dding;lj: oDtuidorable. WaUT U dinoted against tba ' 
bodj in a (all Btream, lud ti appliffd soroMimei to ererjr part o£ lli» 
surface in EQCCMBioii. The deprvtwioo it prodncM ts too great to 
Mdniil of iUi frequent employment. Il is genenllj' modified, and the 
coM effusion nivd in itit plaon ; cold water is dashed in pnilfals oro* 
the auHace of the body. ASosion is recommended in smurtroka . 
wIhd a paliout in strnck down and rondcrod unconscious. Hanj 
jaan uito ould affnaion was employed in the treatment of th« aoat«' 
speciiio fovers, and was caprcJally rwomnMndod in scarii>t fover, — a 
wnll-tned mode of treatuenl oomio^ down to ns sanotiooMl by th« 
anihorityof many of the nbU'-st physicians of ths past gonoration. 
YvL in the pretwnt day the reaction aji^insb all eneiKetio tresktnwnt i» 
•0 great that this moans is now very rarely adopted. Fears are 
flxprosMid ImI serious conse(|uc<ncca should ensne ; bat if the affndan 
is employed at the right period, no appnthanaions need be enter< 
tainisl, OS tlir cTiH-rii'iici- of Curriu and Jackxrn abnnduntly teatifii 
It »liould be cinplnyod during tho early days of iho fever, when tiM 
skin in hot ami the rnah Itriicbt red. 

Currii* and Jackson rocommended that the patient should be 
Biripp«(l, and that four or ftro gallons of vi^ry cold «-atcr shonld be 
daahcd over him, a proc(tf« to bo repeated again and again when thi 
boat of the SBrfaoo returned. This trcatnumt diminisbea the fere^' 
Mtd Mnetiiiiie*, it ia stated, even extinguishes it. (See page £8.) 

Ttwssh a' i>«i« dIpMsIm, I sisll nrwK of tbo of pviinnit; lo draw sUollta to ikai 
UBSMsiBtr •• la Ilia Una of iba kppetnaoe at tit ruli of neuleb II la mnsuHtlyi 
mU Ihal lb* rtttk tf" '"^ ''" lo-on* iny. »<) in tba mwu ILii bobl* t*od. Bal til 
thbabUaasMl Ihars sn varf maBjr tinplloni, wliild aMrlal («**r nA ailltar tMUrfa 
rataa l(a yruiitr Um» or ftppasn pnnctunllr «o ika Hfind duf ; wbUtt tb*« «f HBsU-pW 
appasn as lb« Ibifl. mJ UuI o( Ijpbiu on U>o £(th Jajr ; ihe n*h pI ntaalaa U ray 
•aeartais, appasrtnf MnMimo on Iba firal, aacond, Ibinl, m (onrth dsj, ta ovtn UUt. 
T bail Ulalf ati«i>4a«l afyortonlir al Uallag (ho miIIoiI appraranea at 1^ nwfc la aa , 
tfiUtaiaal mouloatt a bu^a pnbUa Mboaltohaji andtr Mebr. I n avtay laoa 4s 
ibia a|«diDMa IW rash apyaraJ «■ Um Iral ■!■; , lb« etmm bainjt aaieia, tbaifb of abafU 
JoMlii^ tb* MMpanMn lisbsc M 103' aad otUa W 104' rah. In ••«• In 
Uda(4 iha nsh praoaltd tba Itnwt ; Ibiu MraraJ «i th« Uij* tt«U*| paarlj, tbrir toaaj 
pwalura wm wafatlf lakan algbt nail fDorolaf uadtr iha toi>cai, Mid la tvtfni i 
Iba nab appcarrd la ik« aaratnt abrat Iba r«oa aad collar b«Mi, «btUt tba lamp 
waiaaJ aaraal aad did aol rist tU lb* enaiag, -bca It t*a ap to IDt*, lOT, i 

tf«B bt4W. 

Ttaa opparianlljr of aawHalaJBg tba beolwUaa perlad ol arata ftdH 4tmta 
naavbal larnqaest, I «■ ladaeod H pabUBh lbs Mowiaf IM4M «l mnni 

Mka D.falB«d bw hnllf st Baa««U oo April 17lh; oa lb* mniB( of tba Ull 
aba rth fowlr. sad ea iba IWb ■ ■all.gaariiad Mads r*tb appaatal liar la 
Bid M«B wW dU Bot aao bw on tb* IM woiahaasdktolranKatfcalr I 



5B0WeB, DOUCHE, iKD BFOSGS BATHS. 



71 



■ 



■ 



A bnthor tetiiTncd lo icbool on Mijr 3td, Md rvmuDoJ quite irtlt till >t 1 t^». 
OD }ltj 0>» 0tb a iDitiitiinii mil wu notioed, thoncb lie did oat feci at t3\ ill. H« wu 
at oa«* Mnt 10 Ui* iiaaltoiium, a mjlo diiUnl from tUo mIiouI. In Ibe ortnlnc > »all- 
nukad mnaU mh appnuvj oa the fiuw and bod;, tlu tsmprratun botng 103'. 

Apiil ISth M MkT 6th ineliuin— Ifr dajt. 

Min K., bcr ritUr, f*lt pmtlj Mi; itb. Bob kpixaivl lla^ Ath— 17 daf*. 

Ilia Mitrf, anuthar *»Ur, fall poarlf Ko; Bib. fiatli appnuwl lOUi Jim«. Apiil 
18lb M lt*T Dlb induiTc— 32 Amji. 

Al Ih* «uiu Mbovl llr. M. tsit poorlr Uij SOtb. ud TMh appeand Slit, Iho ten- 
ptiaUM bnae 101 '$'. Ua; dlh tv !Olb loRlutiio— IS dajL 

I (Its tb« aoMa of another «bic. Kroivt It., lea rem oU, on 0«leb*r Sltb vlalttd 
bk atniia and >ai with him halt ao hoar. Tbe oeiina had a bul ootd, tnit nait day tbo 
mh ef mnwin appMtwl. KinntK H. vrnt te Mhcol u't eostlauwt wll till Ktmabm 
Snl, Ibal i* 1 1 days from tko time ot bU npnuTe is inroclion |iaclo<llng lli« :!<ih and 
3cil]. H< •»( sot voir ■" 0" Iho 3rd, and at« bii dinocr a> nraal ; next dai, the Ufa, 
lb« rsih at isfatitt apiitargd. Whfn a nonih olil intojilia pnvaiM ia the buuii«, asd 
be vM ^ilLicktil with a» illntai daetared b; Dr. Weit M b* neulei. 

T)iu cue sho** that Iha jwriod of innbatlon iomj laat odI; 1 1 dajri, and tiiat the 
l«v«raptive pariod ia eoatafnaa, ll I* ioMraetiat, ai the iioj bad two attaoluv tbo fim 
ooMiring ■ben be vai onlgr a awntli obL 

IL. a^d IS, wu lint takeo ill on FebrnsiT Slal, and vent to bed. 

Feliruarj 'iini.—ta bod all daj with htJtdn aod cDU(h. Ttmpantare Id mon- 

FehmuT 33td.— Temperalnrs in the nonuoBBS'S*. Cough Iroahloiome, In bed all 

ViXiwu) Hib. — lt(li«r. At II. IE ««nt ilowuiatra to leaiMUL T«mp«catat« b 
■oniniMtl'. At 3 V.iu west to bed a»in, hit kntpciaturo being 100'. 

PkkraaiT 3S<b.— 9 a.H. 1t)>J'. The rasb of meailDt bad nppeand. WhiItt in b«d be 
«M qnlle lulaled fnun alt lie oihrr bo}* of tbe Kbool. On Ibe 24tb, dnriof lb* (*w 
boon ha na up, ho mixnl with tlie boTi of liia f1i^ bat vm nparal* fron tbo n»t ol 
the «b«a1. Ob roiaroing lo bed at 3 r.a. on the 34th. he wai fomptetetf iaalatf 1 from 
Ike other beji, bring pla<Md In a wing of thu bulldlui; CDmniuniditinK with the ml of 
tke boBM by oolj ona door. The iiolntioD wai teinploM. 

On Maceb 39th, i.t., ISlh itj after eipwnre lo U., eight bojaof bii nhool olaa 
(beini all tbe boji who bad not pniloutly had ineulM) aboBod Iho nub, non* of then 
coaplaiaiDC ot anj iUnm till the di; o[ tbo raab eiorpt one hoj. vbo. on Maieh 3Tlb, 
RaDplain«<l (4 eough anJ hail a t*iDptaat<ii« of lOS*. 

The followlnt cafo will anlit toward* deurminiue th* tncolatian period of rfiihein : — 

TsD boff, 1. and O., diaplajed the raab ot tutholu oa Oolober 30tb. On Ibe une da; 
both wire rciDOied Id tbe i^anitorUm, a mile fmn tbe acbool, and do oonunDniealion waa 
patnittad bM««*n the two houR«t. 

Oa Kvtombtr 8th the fHli appcartd on another bor of tbe ■tme lion, i.e., an 
Intcrral of 10 daj*. inelotiTo at iboK on which the nub appeitrad in bnth eatva. The 
iwh app«artd on another boj en tbe lOth, in two otbei* on the lltb, U three en the 
ISO), aod i> two ca tb* 13th. 

Daring the following month S3 additional caaai omnrred. 

TIh folloeing ewe will aauat toward* amrtaining tbo inoabation period ot ohiokM- 
par:— 

Mn. If., went on Jannarj 7lh wiih her ehildrtn to ilaj with d fiisod in th« eovnlty. 
Tbo frito'l'i «hildr(n bMmme posrl; on lb» 7lh, aud the ra>h of chiokonpoi appaand 
M) th* >ili. Mn. VL iniMdiat»l:r lo't "lib bor ohlhlnn ; bnt, Devsttheloa, one ot ber 
cUUrca bceame ill «a JaDoaf; 31th, and cbiokeO'pat lath appeared ao that doj. 



72 



SBOiren, POUCHK, axd eiH>!taE turns. 



AootlMT abild beunie ill on Juituij SOth, mi whi4)i i^ k eo|>ladt orop ot eblcktn-poi 
ta*b appMrtd. U4r* ibv isculwliou [wriail niui btio bNH (nm 14 la IS, ud IS to 
SO dap ntpcclinl;. 

1 ■illili(nH>l>llfiu'tbcrfr«u tb< text, anil iBlroiIaN b«m WBM (hort not*! e( nUiar 
ilngolar cMat of nuup*. A bu; bad aiaiD|ia In ona panUd dnlj. WhM qulU 
twomc-l he weal boou l»m *chool lo rceiig kii lixt drcDith ; be rraiuns'l (bcra quite 
*tU ten <l*5i, and rvtunifd U Kbool in jxrlMt hiallb, but ii«tl Ji; uuinja atUcksJ 
ibt dUht parotid and nu it* ntaal ihouuli mild oHiiaa. Tun olka eaMi o«eamd in 
tbc aaiDs aobodl, in vhacn Ui« 'li>nM hutaidal alMr one ptuMid bad naif bmi aUMkiJ. 
TIm b«f* rcoui&Ml q«it* well for u vsck, and (ban tb* olhar pMoUd elanJ bMun* 
afftoMd, and lb« diMMa again ma ■!« urnial oaono. 

Tb* (olloving U an InaliuiD* of tbc pnaeM* ct eblelMa'ptx tBcl mM>l«a at tb« aam* 
time;— 

D.. nenl 13. 

Mateli 21«. — &( 4,30 p.>^ l«mpentiiTc 9S'l'. W«iit to bod MnjiUlalog «t alek- 
DM P.M. es-l*. 8 r.H. »»'. 

Manh 3JnJ.— 8 a.k. SS*. S r.x. »'. 

Uanb :tHrd.~UI>iciea|>oi vmipltM appwrfd tbli moislD(, ^K. M*. t r.M. W.i\ 
All dij tbfl boy loll qaila volL T]i« taak <raa «ell-DMliod. 

Kanh Mtb.— ai.li. 93'!'. Bloiabr >pp«*nno«oa tbefatwuidbohisil cuil 11 «.& 
nib pbliifr. S r a, nndmbtadljr «iMalnk 

iUKb 2M.—X.*. 101*. Maal* lub ««11.mirh«J, r.M. lOr. 

UarchSSUi.— LM. 100-3'. r.M. lOtf. Baabof UKuIe* pragr«ailii(. 

Hanb 27lb.-*.lfc lOI". Ml. W-8*. 

iUrth SSlb.— t.K. M'4*. From (hli tlmo lb* tempinttiircMintlaiud nonnal. 

Tba (ollaviaf ii an uaUoae si tbc appcaraec* of sliiilMa-poi nah a f«a ^ji after 
tk« diHiiiiptataiita of maMica i— 

P., 1 1 jma old, Mtkcnnl Manh ITib. 

ManAI»lfc. XtMls rub ap|«Mtd. p.m. 103-S*. 



UftKfa soui.-^tt. inir. 


r.M. 


lOS-4'. 


>■ 


SlaL— „ les-l*. 


i< 


loa-r. 


ki 


llaiL— „ M-r. 


■ 1 


loo-r. 


t> 


SSnL— „ sg-S'. 


■ 1 


M.r. 


*• 


MU.— „ M-3*. 


»• 


no*. 


«• 


»lt.— ., 89 r. 


fi 


M-4.* 


ft 


2«tk.- „ Itt*. 


*t 


»•«•. 


■ v 


»lk.— „ tBtr. 


1* 


M-8». 


K 


Stik.— „ M-S*. 


•t 


loir. 


" 


Wtt- ., Mi'. 


» 


w*. 


CIMm-PM apt«u«d la U» attarnoon. 






tl 


Mtb.— „ »»•. 


ft 


M-4*. 


„ 


Slat.— „ »■«•. 


*■ 


VV-S-. 


Afvil lit.— ,, BIhr. 


1* 


lor. 




Jai- .. «»•. 







Ai feUottfav b M IniHwH tt Ivo allMka af mMttm acBirriai la lb« mm tmt U 
tlM «■« bar :— 

D., tl )«an aU, ImI a •U>t> atUik o( laatitt i« Maf, 1178, aad tfftU b Hank, 
187*. KrilW Utark wai lanv*. 

Tbo doiMba mkI dliutoa tn gancnlly «u|4ojriNl for Uuiir looftl 



EBOWXR, DOUCHE, LSD erOSUK UTBS. 



73 



I 



eBoeta. The; ue of tlio gre«t«8t sflrrtco to rouse a paluinl frojii the 
atnpor of drankeBoou, or trout (liat of opiom p^iifwDin^ : whni & 
eortain iiUt|^ of tlifl potsoaing liaa htvn reached no other traatnont 
ia ao efficacious. EsoMnTe tippling or aa uvcrdg«e of opioni i»ilaces 
■inpor mora or lesa profoniul, when lh« moveroenlN of raspinttioii, 
Bt first languidljr porfonned, »oon atop, Knd dntb b; uplijxia nsulla. 
At tkU most critical titBge, cold affuatos, or tke cold doaclu), applied 
fneij U) llie b(^ad. is ^Derallj aulficicint to ivmove the oonditioos 
within the eikull on wLii-li tlie stupor depends. ConsoiOttaiWH i« 
restored, tlio brcatliing^ simulianoomlj agnin bvcoiues natural, and 
for a time, at least, the fear of a simmiIiIv fatal termination is tot at 
revt> The water should Iw [wiiivil on tho ItvaA from a good beigbl. 
ao aa to aecare as great a shock as possible. The Tigonr of the Appli- 
cation most be rognIat«d bjr the pnbw and gvnentl state of the 
patient. Tlie breathing be«.-omM deeper and mora froquvnt, the livid, 
bloated Mpoct of tbo facn soon disappears, whilo the poise ([rows in 
strength. It oft«ti havens that relapses ooonr, wli«n the aSnaion 
mast bo again and a^iin (employed, so as to snstaia life long enongh 
to udmit of the elimination of tlMi poison. If promptly and officivotlj 
applied, life mitr bo snrcd i-ven in tbo moiit nnpromiiting cases. It 
Is all-important to ply tlie initor abnodantlj for some time, and from 
a good bright. Some time mny elitptto befbro any giiod offeets be- 
came risible, but if the polso and breathing improve, or become no 
worsa than bcforo thn douche wna tricil, its application should be 
oouttaued, and persovemuco will often bo rewarded by success. 

Many ouaea of furioun mnniacnl delinnm may bo quieted by tlie 
Dold douche. It mnst be borne in mind that the douche is a pon'or- 
fnl remedy, which makes it necossary to carefnlly watch itx effect 
on the patient's strength. To obviate exceicsive depressiou, it is an 
oxoelUiDt method to phuNi the pntient in a wanu luith, anil to apply 
cold to tbo bead in the manner just described. 

Sm-ere pain in the h<!nd, met with in acute speci6c fevers, or i»- 
snltiof from gastric disturbance, may be relievi-d very gnttefally and 
eSectually in the way recommended by Dr. Hughpa Bennett : " A 
waabhand-basia should be placed under tfau car, and the bead 
allowed to fall over tbo Tweel) by bending tbo neck over the odgo ; 
then a stream of cold ivat«r shonld be poured from an ewer gently 
over the forehnid, nnd so directed that it may be collected in the 
faaatn. It should be coutinuod as long an ngnianble, and be rejiealed 
frequently. The hair, if long, i^hould bo allowed lo fall into thv 
cold water, and to draw it up by capillary alt tw- lion." The ice-bag 
may be conveniently anbstitnted for this appliL-ntion. Dr. Hughes 
Dennett agruca with Graven, that in some caeos rory hot water acta 
moni sucoessfully than cold. 



74 



THE TtlBKISI BlTn. 



Tlio onid doncbo ii iilso an flXG*ll«nt lonJ toDW to indiridnal jmHa 
of tbd body. It mil}' bo emplojod to ivmuve that sUffni»d iu joints 
ivnuiiniiig aft«r slight injoriM, or roeatting from rhoutnntiHm or goat, 
and Hdt mn; ndviuitageoiuljr be ndded to the wftter. Th« tonx of 
tha douche's impact on the offoctod fMirt, with tlio dtmtion of ita 
ap]>lioalk>ii, mnitt be regulated bj the eonditioo of tb« tiwncuu If 
very weak, it i» belter at Gmt to plaj tho wat«r in the neigh boa rliood 
of tho injniwl or wtnkenud joint. It ia alio usefal in chronically 
inflatned and awolleD joints. In the early stages, especially whrn 
teniliTnoiB puntalK, it i« nm;fiil to imniorsa the part in hot water fur 
twenty to thirty m)nBl«H, and iniinedi»t«]y on reniorinif the joint lo 
cold doncho it cithor in a iiin|^» stnain or through a rone for um^ to 
two minates, well rnbbing the joint afterwards till it glows. Dr. 
Fnllur rvoommrndii tlifl cold doncho to bo ptayod for ooa or two 
minatefl upon joiuia affected with rheumatic arthritis ; or the water 
may bo slightly wanned in wtator, aod th«n the parte rnblwd tiU 
they are warm and dry. 

Unch good may be ftffoctod is spormntorrlifm by ttia favo appli(»- 
tiou of raid water to the pvrinnum and buttouka aervml times a day, 
and by th<t saspi-naion of the taatiiJc* in cold walor for a few minutM 
night and nuiniing. The same traitment ik nuefnl in rariooeolei 
A oold-wnter injection of about half a pint every morning bafon 
golnit to kIooI mlieres or oni«ii pilcn in many case*, and ia always a 
■scfnl addition to other treatment ; and injections of cold wiiler am 
bighly reuommendod in ohronio diarrhtna and cbronic dynenlery. 
Many porsons, specially women, are troubled with oold foot, par- 
tioulnrly at night ; m oold, intlucd, hk to tiScotaally prercnt sleep for 
hours. Tliia condition, whioh may rank aaa distinct ailment, is bmt 
tnaiod by imnioniing tho foot nightly for a fuw roinuto* in cold 
WAtar, rubbing tliooi, whilst in )h« foot-bath, diligently until they 
baeomn warm and glowing, and tli«n, after tliorongh drying, clothing 
(bm in thick OTorUrge wooUon or " floeoj hosiery "aooks. 



THE TURKISH BATH. 

TniH bnunng and dopumting Wth combines many of tho properliea 
of tho hot and ould bath. Tlw body, subjected lo great he^ la 
niadv to [lonpiru oopionsly. If the both ended here, mor« or leas 
woaknoae would ansae i but at tliis tlago the froe application of oold 
water sbmubtes ud hraoos Iho body, and prodnoos the tonic e(fei*ta 
of the oold bath. At each stage of the prooea, the Turkish talh 



TUB TDBEIEB OATIL 



76 



I ; the penpimtjon cnrr^ing off, itnd Lke coltl cnn- 
Bamlng, by mrrcMod oxydbtion, effot« and noxions rafaBtanoes (n the 
blood. 

Tim Turkish bftlli, like seo^ir and Bm-batlitngr, is a tme lotiio. 
By a bmtc, I ondKnitand. atiy menae which tnl) tiK-rouo both the 
dntmction and the co&atruction of tiMoe, providi-d tbu conitrDotiTe 
mnftina in exoM ot the deetrootiTo proceM, and bj promoting tbo 
natrition of the mnBcular, nen'ous, and other BTtrtcnu, tonioa ineraan 
thv ptXentiAl forve of tho bodiljr organs ; in other ^noria, toBoes 
inct co e o the eapaciiy tor function. Bj increuaiiig tiune cfaitnge, 
I tonioa proDoto appotilo and <l^e8tion (see Cold). 

The bMhc, says Dr. Gooldcn, an nsefnl in gont, rhunniatism, 
klica, Bright'B diacase, ooxenui, and psoriftBie; thef benefit bron* 
[chilw, thii' coogU of phthiais, tbu auliing of mn«olos from nunBoal 
exertion, pains in (be goat of old iround», oolds in the head, qainstesi 
^aad oommun wiatvr eoughx. 

]t is not amiss here to caution peraonB prone to colds, that the 

bji of orrr-ctothing inoraajtee thin linlHlitj. Tliis cold-catching 

P'iendenojr may be obviated by nsingr a modmtc amount of clothing, 

taking a cold ■pangti'bnth erery morning, nnd occnnonal wrt-idicot 

I .pooking, or the Turkieb bath once or twioe u vieek. 

On catching void, a patient with Innpi proriously health}* becomea 
troubled for some time with chrouio catarrh, accompanied I7 oonsi- 
deniblo oxpoctoration Mtd some HhortucMand oppramionof broalhing. 
I In iiuch a cuw, the Turkish Imlb f,fner«l]y affords piumpt and greU 
pelief, checking tliv oxpoctontlinn niul easing tbo brvathing. In 
onchia] asthma and Gmph^^enintouB aatlinu), a course of Turkisli 
Bay one orery second or third dfty, is very nncful ; this Knbdtii-x 
Fehronio bronchitia and renden the patient lens liable to cati-h cold. 
A lafge chaaotB leather wnislcoat reaching low down tho body and 
arms, and worn over tho llannol, affords gre»t relief in bronobial 
asthma and omphyMnutous brouehiiiii. TbiK jacket is extromely 
wttrm, and protects tlie eluMit ai^ust the ricisBitudes of weather, It 
ia B naiity practice to wear it nvxt the skin. 

At the ooouncnoement of n fuvonsb cold, a Turkish bath will cub 
I attack ehort, remove tlie aching pains, and relioro or euro tbo 
LltoarMuMs at onoo. Tho bstli will Htill pn)Te very nxcful for a cold of 
eevoral dajs' standing, though ita good efleota are less strildng. The 
TurkiKh bach will rvlici-e or carry oEI the remnina of a general sorure 
leold, as hoarseness, oough with expeotontion, and lasnitade. Whilst 
Ibe botcbamborthevoicegeneinllyhecomeBquite clear and natural, 
hongh the honrKcncsB m^ afterwardB retnru in a slight degree ; but 
it asunlly continues to improve, becoming natural in a day or two, a 
repetition of tbo bath aiding oomploto rocorory. in more olmtinate 



76 



IHI TUBKiSU BATH. 



OOaMWTvrftI batliH nuijlw required. Great improvemtiiil of the voice 
in the bol clutinber tuajr be taken as a proof that tlie bftth will benoGti 
even tbongli, nttin lliv bnth, the boAmcnoM returns to n grvhl extent. 

Tbo I'orkigh bath is wrvioealilo lo perKiiia wlio after diuiii^ ont, 
not wiaeljr t)ut lov well, EtifTttr nmt day from malaim und liligbt 
iBdiR«Btion. A courae of TurkUb batbs ia verjr boDC&cia) to town- 
dwellem leading u Mdontary life, wbu, intpooialljr if thcjr live fruely, 
are aj>l lo become ntout willi aofi aud flabbj tiaanea, ar« e*si)y tirvd, 
aafTur from lack of onorgy ond soma mental deprMnon. Umkir tliu 
iaflaance of tba katli, tli«ir muscleM boi-ume firmor, tlie fatooM 
dacmaoe, and they aoqaJra tnoro spirit and cuorgy. 

A oouracof Turkiak bntlia ia nsoful to pntivnt* whotM b«allk liaa 
broken down by rosideDc« in a tropical iilitaat^. who aalFer from 
{[eneral debility, cnfe^hlcm^nt of raimi, dull ochiiii; paina in the heud, 
and broken slcop. 1 have huunl the Tnrkiiih bath, even its daily xtw, 
recoinm«ndc«l highly for convaloecents from acnte disea«M, to promota 
asaimilalion, digestion, and appetite. Pationta aiiRonng frum jann- 
dic*, acquired in n tmpical climate, or from mnlaria, bare otti<n lea- 
tiHed to the beiiulicial e(fec-l!i of Turkish batbH; bat it ia uccesMry, 
aa indeed it is with nil pereons with ahaltered health, to caution them 
ag&iosl the too vigoronii and unraxtrained nm,i of the batb. The 
patient should learc the hot chamber aa boob aa free perapiration 
occurs, and shoalil not plnugo into tlio cold bath, but take a douobe 
with slightly ttpid water, Mjjecially in cold weather. 

Many drmd the Turki«h bath test tbcy should catch a oohl. aod 
one often heara complaints of a cold coming on after a bath. 80 far 
from tending to ifivu cold, theae Inths, as we have laid, obviate the 
tendenoy to catarrh, and fortify delicate peraona against a cold-caloh- 
tn^ londeocy. If over the bath i* answerable for a cold, it is almost 
always owing to the balber leaving the batb-ltouse too soon, pvrhupa 
in ioclemeat wntthef, whilst his skin is still poraptrin^ freely, or hia 
liair is aoaking wet. 

AgwR, il is not nnnsnal to hear ccmpUinta that the batli haa in- 
duced cooaidemble depreaaton, or even exhaustion, lasting perhaps 
aeveml days; but bon again the fault raila with the bather. The 
bath must bo adapted to tJie strength of the patient, and it is always 
pradentlo take tiie first bath circumspectly, the bather not Kla}ing 
too long in the hot chamlior, and nmlergoing the braciug appli<-Btion 
only a few seconds, willi wator not very cold. It i* <liflioult to point 
cmt the precise time a bather onght to remain tu the hot (ihBiub«n'. If 
(lelicutK, «nd il is Ilia lirat batli, he sbonid not enter a cltombor hotter 
llwu 1:10' to 140' Fnb., and abonld stay there only twenty minntaa 
or half an hour, or Itas, abonld h« feci faint or tired. The patieat'a 
wnaatwus are the heat guide ; soiaetimus, ospcoially it autferiag (roni 



I 



I 



I 



TBI TTBKISn HATU, 



77 



pain, tbs bath aootbea and cases, and tlien he eiui ramain in tho tiot 
clittmber an hoar, the firxt bath; but, I repeat^ h^ ehoaldatonce 
leave whan ho feels faint or lired. At first, the patient, not imldom, 
on oomoicnciiift thu liatti, fiLilii to pmpiir' ; in this chao, ho should ho 
removod from tho chnmbcr in ten iiiintit(>!i. haru warm watLT poured 
orer him, and be well obnaiponcKl, and, nnlcu ho is tired And faint, 
shoald tb«n return to tho hot chamber. It is a mln in thosn cntab- 
lisbnients to adrbe avnn an ohi bntbnr not to cnt«r the hotter cham- 
ber of ItM" to220* Fah., till the skinh&s beooine tDotnt with perspira- 
tion ; thuufrli manj disrogard tbiE injunction with nppRront impunitj. 
Even if tho lirst bath cansesj some dopression, this nut-d not happen 
aftenrardu, partljr bocan«o the bather will have hncomo aeoustomed to 
tba procoes, and partlr because he will know how to adupt it to liia 
abCB^h. Yet it must bo admitted that some persons, even with 
•very precantion. cannot take a Turkish bath withoat expericuoinff 
ninch depression. 

Acnto rheninatism and acnte f[ont have been treated with theso 
bntliM; hnt. ils in moiit inHlanncH, the severity of tbu pain renders 
it inipracticablo to take patients thus affected to a Tarkisb hath, 
a modilied snhRtitnl« for it, Hhnrtl;f to bo dcHcribeil. may be tjikoD 
M home. The acute pain of Rout, it iit said, disappears in tho hot 
ebamber, to return *oon aftorwardit in a diminished deffree. 

The Tnrkish batb is particnlarly valuable in snbaeute and 
chronic gout, but, aa might be expeated, it i» not in all cocoa 
eqnallf serviceable. In long-standinK ca^es in which the attacks 
bare occurred so frer}Dently aa to distort tho joint* by deposits, 
and patienta are, perhaps, liable to repeated relapses, and are 
ccarcoly orw fn» from pnin. the efficacy of the Ijatfa, tliough strik- 
ii^, is leas apparent than in milder and more tractable forma ; yet 
even in tbeeo sovcro cases, the bath affonls considsrablo relief by 
diminishing the frequency and severity of tlie relapses, and by 
reoMving the pervading ecneation of inralidiam. The TurkiKli bath 
ix, perhaps, more uiEcaciona than other remedies in a case of tfao 
following kind : — A patient ioolined to stoutness complains of slight 
siul fagitive pains; the joints, bnt little swollen, am merely stiff 
and a little red and hot. Tho gout nffectH many parts oftiTn in 
■neocKsion — thu joints, the head, the back, and perhaps some of th» 
internal organs, aa tile bladder, &r. During an attack the patient 
complainH of maiaUt, and his complexion often becomea dullish. 
Tbo tissues are often soft and flabby, and, in »pit« of judicious diet 
and almndant exercise, the patient may bo seldom free from some 
cvidimco of gout, snfEcient to annoy bat not to disable him for 
wrk. After one or tno Imths the pains, the swelling, and the 
maiaiM disappear, tho joints become sapple, and after a tim^ tlio 



?8 



TBI TDBEIBH BATH. 



baliis beiRK oontinncH, tbs comptcrioa lose* its uIIowimsb, tho 
tiMaflK bcoome ILtin, »ad th« andoe sloatneM undorjcouti diminiilinn. 
On (lUcontinnin^ lUo Irntb*, thn gonijr sifinptonia will often Konr, 
ognin Ui (liMip(ii!ar uii the roeumption of tbu Irentment. A gon^ 
patient niKf ftdnntBgeonHli^ Hnppluinent tbo action of the Turkuh 
jjktli by drinldng oevtitin anilable natar&l miueriU vmtuni. 

TUc Torkisb faotli U nsofnl in tbo VMions kindfi of chronic rbnn- 
matum. 

A patient who, in damp weather, or dnrinff an mat or norlh-cnnt 
wiudti, Bafftin from atiffncM and pains in *cveml joint*, will duriTo 
mnuk benetit from a Turkish bath. Tho ahonlder joint i^ otuin 
altecte<l, tho pain and tondernuHN beinj; Eroqnostjjr limited to a 
Bmnl) Kpot. 

Again, a pataant witkont anj- previaiu historjr of rlienmatiftm 
fiBdj) hui «Uonld«r Mt fosl. ia nnabie to more it. «xoepl to n limited 
extent, witbont Rreat jiain. Here, again, tho pain and («nd«niiMS 
may l« very urcamscribed. In atioh a com a Turkiih bath gvw- 
nlly aSordN grvat rclitrf. Qalraniam, loo, oven one applioMMm, 
irill often entirely remove or graatly leaaon Uie paina and stiffnan, 
AgaiDv lh» Tnrkiah bath niveu much reliof in mild and ohnmio 
rbeumatoid urthritia, and often rotarda th« marefa o( thia diaaaw. 
The bnib oftim mlit^vva lumbago. 

Mr. Aliltun finds (Jm bath naeful in altayiog tlui tormonting 
itchicil of pniHgn nneonnaotad with lico. 

Should it hafipeo that tho ragular Tnri:iNh tiatb ia noi arailabla, 
thoa ono or otlxr of tho fottowing modifioationa of it tony \w Hob- 
irtitulad ;— Thn patii-nt, qnite ni>k<<d, aoated on a mc^er rhnir, wttb 
hi* foot on n low ntool, ia onvolopod in two or three binnlcots, the 
liMul alon* betnff vxpnaed, nnd a spirit Inmp with a tat^n wick ia 
plDoad niider tlui cliair. In atwat n <)iiar(«r of an hour jienpirBtioii 
■|jrt>ama down the body, and thiH Mvrelion mny W inomaaad br 
drinkJiiK plentifully of wnti-r, iind by pliu^in^r a pan of n-ntvr orw 
iba lamp. Whru the juilient ha* pi'ntpirtid miflieienily ibo blnnktita 
arc qniokly mnoTod, anxl one or two pailtula of cold wntor an 
poured orrr htm ; or, if this «ffn*ian ia too boroic, ho may step into 
a gvnoml both at 80', or, Iwttor Hill, a, few defrroea lowor. Dr. 
TayW, of NoltlnEfaam, lindi Itiia Irentmpnt narfnl in ohatinata skin 
■fl^tionm Hii-iimatism. cntnrrli, Bvphilis, and in mdncinK atoitnaaa 
arialBft from an inaotivo lifu. 7'bo iuatramrtit makera now anpidy 
ooDVvnient forms of the doinestio Turkish liatb. It ia fnr battar, 
bownrar, when practicable, to employ the Tarkish Imth ilaelf. 

Dr. Nnvin biKhly rooommenda the following luwdy atmm-l»lh 
im tlip tnMtment of ooale rhvomatiaai, arailablo wbm the paticui b 
lying boljtisaa and irrMDorablo in bod : — A conple ol common red 



I 



POULTICES AVD FOUR » ATI OXR. 



79 



bricks ara placed in aa oreu hot anougli fur Inkiog bnwd, and in 
half Ml hour or A little more. th«5 are suffictentlj heated for tbe 
parpcHW. The patienfa liody linen iMi'inj; been prerrousljr raiDOTed 
tlioM two bricks aro folded in a piece of comnion tJiiok fbnnftl, 
thorriaghly aoaked in viDegar. nnd Inid on twoplat<is; ono is to bo 
placed aboat a foot distADt from ai)« ahonlder, and tliu nthc^r about 
vqnatlj dJitant from tho oppoaite teg, Aod tho bcd-clotbcs arc thra to 
corer tlie bricks and the pationl closely roaod the neok. A moat 
refreshins: >u'id steam-bath iit Ulan obtained ; and tlto Kopplj oC stMtn 
jntty ha kept up. if neoOMar^. bf nmor'uift one brick and ivplacinff 
it hy anothrr hot ono kept in reaervc, Whi» tho patient Las bwn 
in ihv bath (nr fifteen or twenty tninntes, the bed-elothm and pLatoa 
■bould bo rcmored, and (Ao yntu-nt iiittaiUtti mopptd all over, wry 
nipiJly, tnlh a totetl teruMir oul in coitt tcater, and then qoiokly 
nibbed di^. Dry warm ]in«n mniit bo pat on nt once, and dry bcd- 
dotbca miMt replace tibose which wen; on tho bt-d pFurioanly. The 
undeivtheet can bo removed, and a dry one subatitoted by foiitonjng 
the ooniera of the dry alieet to thow! »f the damp ono; geaeTnUr 
very little difficulty ts mot with in aimjily dianiug tho old eheet 
from nniler tlic putient, when tho dry one follonn it, and is left in il« 
plac«. The patient ordinarily oxpcrioucM great and Hpcvdy mlief 
from tliia hath. Thu exbaoatini; aweata are lutially diminished, and 
Uio neoeasity of opium mnch leascned. The change of tho body 
linen can bo onsily aocomplialied bj to»rinff tbe night^ahirt open from 
top to l>ottom down the back. The Rt«ain-batb anit RnbMcqnent oold 
diiiuUut should be continued After tho gmticnt is nblo to walk Abont, 
aa Uiey oontribnte to the heAKhy action of the >kin and promote free 
nohitity of tho jointJt. After the patii^nt in able to got out »f Ixil, 
the bntli may be adminintered in tho manner previoualy described. 
Th« steam-bath, according to Dr. Sieveking, relievos the pain and 
checks the perspiration in aonto rbaumatiaui to a degne bo has 
failed to Atlain by any other treatment. 



POULTICES AND FOJIKNTATIOXS. 

FocLTtCES nnd fomuntntions, in such common use, are simply local 
bathn applied to tho skin. When its surface, or the siractnrcs 
iM'uuuLh it are inflamed, pouUicos and fomentations are a couvctiiont, 
and efficacious munoH of utilising warmth and moiittnro in tho Iroat- 
ment of diseased parts. Tho wnrmth and moisture relax tho lisauca, 
and in tome degree abato the tenciou duo to ioHammatioo, and ao 



80 



FOCLnCRE AKD rOVBHTTATIOXe. 




nli»T« pnin. Applied itt tbo vorj beginning to inflamed tiseiies, to 
nbtoou, inflftmod pimplee, nnd the like, pouttiooii often summnriljr 
ohock tho inHnmniation, oad pr«vf^t the formation of pus. FoniMi. 
tations with wut«r M hot oa oan bo I'nduntd nisn arrptt indnmiiuitioR 
and chock tbc formation of matter, and shonld Ixt genOTallj* emptojed 
lu Mljonotii to poti]ti<!C«. Hot foracntutionfi nill ottca disporw or 
restrict tli« devolopment of acno indnrato, herpes labiftlis, nud similar 
tBflaroed pimpica apt to appear an tbo (ace. 

These applications aro of further ose when stippuration has set 
in and matter r(i({tiirMi to be oxpollcd. Poiillii^is ^rratlj facilituto 
the passage of the matter to the snrface nod further it* eipulsion, 
while, at the samu time, tliey limit comuduntblj the spread of inflam- 
mation in nil directions. Ilore, s^^in, verj hot fomentations, oftvii 
repeated, continuod for ttrimu time, an: n useful sapplcmont to poul- 
tices. 

Jt should bo rvmembcRid that much depends on the lii-at of tho 
Application. Ponltioes should be alwajs applied as hot as thej can 
be bomo, and shonid be fr«qacntly chan^d, leitt tbcj become cold 
and hard. Indeed, they can scarcely bo changed too often ; in 
hospital practice it is diflicnit to constantlj renew ponlticc*; jc% 
oven ID such institutions, where the supply of nurses is limited, 
ponltioes should be changed at least every two or three hours. 

When applied to disperse inHammation, or to Itssten the m&ta< 
imtioB at abaoeasus, tho poulticvs sboald be lar^, rvacbing brjrond 
the limit of the inflamed tissues ; but as soon as the absceea or botl 
has matured and bunt, the jioultice nhould bo rery little larger than 
the opening in the skin through which tbo matter escapes. A large 
pooltio*) applied over-long. rioddeiiH and irritates tho skin, and ijt very 
liable to produce an eruption of ecHtlU, or to derolop fresh boils 
MWind the banc of the original ono. 

la the treatment of boils, carbnDoIas, alMOcaHR, and inBamed 
lynpliatka, it is an excellent plan to amear orer the iii&amc<l tiiiHne* 
a ccmpoiind of equal parts of extract of belladonna and fflyoerine, 
and on this drcasiag to supvrimposo a poultice. The beltadoana 
easM pain and redneca inflaramation. (See Sulphides.) 

In ovdor to protect the adjooont timaea from tlio ondue action of 
ths pooltioe, M aa to cheek the prodnotaoa of fresh trails, it is a good 
plan to jilaco over the boil a piece of opium plaster with a circular 
hole, nod to apply tbo poullioe only over the plaster. Another 
protocliro |klan is to smear the coDtigaona surface with xino oinl- 
menL 

It is far bettrr to tnal a fully devolopod ahooMi, nody to bv 
oponad. by Lister's carbolic acid method than by {•naltiooa. 

Poolticea moderate tho inSonnutioa oad alleviate the paui in skin 



FODLTICKa AXD FOUSXTATIOSS. 



81 



diMUM, u ooKGina, Ac, wlicn thu Nkin m highlj ioflanwd, psiDia), 
nd, and swollen. 

PoulticMi aro not only Boothing wimn in diroct contact with in. 
IUiukI ttssDC!!, bnl they appenr to act iu the ntne maimer on deep- 
BMt«d pnrto. Lniyc ponltiocs npplicd rorj' hot, and rvmorod m sooa 
M they bMWine cool, ore of f^nat service in pnenmonU, plenriay, 
bronchitis, pericaitlilifi, pnrihinittR, Ac To avoid oxposnro of tha 
mna moist skin, the old poultice shoutd not be removed till the neir 
one IN ready to rttplnce it. 

These applications aro extremely naef al to children attacked with 
lironchitiii, brcucho- pneumonia, or lolnilar pnoamooio. As yonn)^ 
children are apt to be rastless, and to loss about in bed, tho fittiri) 
cbett nhonld be enveloped in a jackct-ponltice. Tho onlinary poultice 
800D become* rocked np, and converted iuto a narrovr band on- 
CircliRfj only a very limitiid portion of tho clivxt, whiUt tho nncovorod 
part of the cbost is exposed to cold- Tho jacket' poultice should In 
constructed with a piece of linen inifficieutJy largo to go ([uito ronnd 
Uie chest, and tapes slionld bo sewn to it in such a manner that they 
CM) bo tied in front, and over each shonlder. It is n» wvll to have 
thiM pftirs of tapes, so as to a<lDiit of throe histeoings down the front 
of the diost. 

To eaalile a pottltico to rctAin its heat, it should be cpread an inch 

'■or more tliick, or it may be made thinni-'r, and externally coated 

witli ft layer of cotton-wool. Tho cotton-wool beiii;; light, it doc« 

not hamper tlio brvathing — a matter of tmiiortanco, e^ecially with 

children. 

Ja inflamraatJon of deep-seated or^na the same molhods, modified 
to Buit the part, should be ndoptcd. In peritouilis it i* of grwit. 
imporlftnco to spread the poultice tJiin and cover it with ft layer of 
ontton-wool; if heavy it agj^vatos the pain. 

Ponltices are aeefal iu acute rheumatism, lumbago, soiatica. 
plenrodynia, myalgia, and in those BO-callo<l rheumatic pains which 
often attack limited parta of the body, as one arm, Ac* They are 
soothing niul pleoaaut to tho inBamed jointa ia rbenmniio fever, 
although cotton-wool is often preferred. In ooate lumbago, poul. 
tiding often brings spcwly relief, the KorcrMt eases being greatly 
1)eaeBted in a few hours, and generally cured in one or two days. 
Tlie poultice mnst be T«i7 bot, and hu^ enough to cover the whole 
loins or part oEoutod, and thick enon^ to remain (|iiitii bot for half 



* Qaltaaina ii hifliljr nutal Id toma fonni of (boM eoaipUiDl*, wpwiallf in luni- 
huga, ]■ wikUca itgJTta Bt IdhI um|<Q[ar7 rtlitf, ud In ■UD^eiiMastcwiiiiplica'iani 
cffMtaMT*. ScUtioa ud ilMp-Malnl [ntlni aliout the >WLt of llif long boDB, otn 
th* dall ath4ng |un ia Ihs Jotaw, ■hlcb not antra (tnontJf raiiiftim a(Mr kii stuck of 
•out* ill IIS— lain. wU oftca jwld lo fUtwuim. 

O 



82 



nCLTtCSS t!tP rO)IK]ITit[OX5. 



au hoar, when it most be rhangivd. If th« pnin ia persistent this 
tn'klmciit (houlil b» continurd for three honn, or longtT ; lliu xkin 
mast then bo covered with « piece of flannel, and tho flannel ooverwl 
vrith oil-nilk ; thi» nEtcr-traitninit promotv, what in romit deisiittble. 
free penpi ration. 

Whon olcctricttj. tho nooclla, or poolticw, ftiil U> fpv» man thao 
tiiglil teinpomrj relief, it nill often bo fonnd that th« lumbago ia 
acoompaaiMl with bigh fovcr, t)ving nnmctitneH tho fir«t Bymptom of 
wi attack of rheunutliu fever. 

Sciatica mnj be treated in the nme wa^, Imttlie reiiaU in not«>flen 
Kt witisfaotoiy. (Vitle Ether.) 

I'oalticvti apfilicJ in tb« luime way as for Inrabngo, and followed 
bj tbrt itfijilii-iition of lint and oilskin, arc oft«n DBofnl in iorere fornw 
of i>loan>(lyt)in and mysl^a. Belladonna tininiant ia nnually Knflicicnt* 
nod oven to be preferred in pleorodynia ; and MtnetimeB other apraj 
at ooceaad pennaoontly remove* the pain of thin annoying affectionu 

As we baro taH, ponllioca may be mailo of TariouB subHtaaoOft 
linseed -meal, oatmeal, lirad, or nUruh. Kneh ba« ita peculiar 
oharacl«r. L!n»ecd-meal and oatmeal poulticee liave moat propertiea 
in common ; they mnko oompaot and only slightly pomna poultiooa, 
tvtjuiitnp heal and mointuro lon^r than other kiiKU, and are eon- 
iN»]ii«nlly often to bo preferred to bratd or ntan-.b. Itnt Iiiisr<»I 
contains an iaoonriderablo qnantity of ncrid matu-r. wliii-)i nonie- 
timM irritataa, Mpocially if the skin is of a tinv and dolicnle tex> 
tuns or il it in inflamed by som« omplioo, in wfajoh oaae o«1dm«I 
or bread mnst bo snbatitnted. Uronil ponlticM tarn man porona and 
l>liu)iler tbiiu those of tinseed-meal, bat ths poroslly dopeoda rorj 
gmtly on the way of nuking them. Bread ponltioM oool more 
qnickly, and give less moiRtnre to the akin, than those matlu of 
linsoc<l-meal. Starch ponltioos rolaiii their hint for a conaidenible 
time, anil am rerr blimd, unirrilating applicationa. 

It 18 as well to mention Uiat linMiiil-nienl poultic«a are more 
tanaeiona than tliow mado of bread, and an therefore low liable to 
break np aixl fall about the bed and olotluw of tho poUonb, rendering 
him nucnmfurtnbte. 

In makiofT a poultieo, oara shmild be takoi that the water boils. 
and that all the matarials, linsood-meal, linen, strnppinitii, bnndagM 
or t*pMi wool and oil-silk, are eluao at band ready for bbo, and 
idaoed beiora a good Ore to bo tlioronirbly wannod. To mannfaotnra 
a UnHmd ponlMoe, sotBcient bniling wai^'r shonid lyt ponn'd into a 
haatMl bowl, and tlin mnal mnat 1« ignickly s;>Hiiklnl into the bowl 
with OM hand, white with the oth«T the mixtiirt' innst bo onostautly 
atirred with a knife or apatuUt till an&iodmt neal haa lieon oddm) 
to make a thin and smooth dongh. Tba mizturo ahonld be oom* 



F0VLTICZ8 AXD rOUKSTATIO.VS. 



83 



I 



poinded aa mpidly u pnuiblo, othcmrim tW ponltico wLeu tuatlc 
will bo ftlmost oold. Only an eiperieuoed hand c«n niako a. model 
poultice. By Adding tko monl to tho water, with consUnt mirriiiK, 
instead of the water to tli« meal, a Utoroaftb blcndiog: of the tno 
inTTcdients is onmrod, not n knvltj', lamjiy, nncnmfortftblo muM, t«o 
oft«Q voxing iiutead of soothini; the jxitient Tlio dough must th«n 
bo spread qnicklj and avL-oly on the warm linen, alroodj' cut of 
propnr Ktxe and «hape, the edg«e of the linen tcrni'd n little wajr 
oror ih« tae«l to provont unj portion Moapinti; bef ond the linmi, and 
to protect the patient's clotho*. 

ThAre are two method* o[ niakiDH bn-^d ponlti(.iw. One way is to 
out the bread in thickish slices, put it into a bo^n, pour boiling wat«r 
OTor it, and place tho imnlcing mii«a by Uio tirt^ for (ivo minutea; 
then ponr nff the water, add ftwh boilini;; wat«r, and plaoo liy tho 
fire; aflern-ards draining tho linrAd.lH'At np witli a fork, and s]>read 
tlie ]>onItice, The other plan is to cot stale bread into thiok Blit'os 
into a Bancopan and ponr cnongh boiling wator ovor it to pover it; 
plat'H the whok- by tho fire, and allow it to siuuniT fur a short time, 
then Btrato and prepare the ponltiiie. The finit plan makes a 
porona ponltJoo, th« Hecond a more compaot poulUoe, sharing tlio 
eharaeter of linseed'mcnl. As we aliatl ncc, each poultice baa it» 
fitting application. 

Bmn ]iotUlicM are uMi-fu] on aoconnt of tluur lightness. 

Starch ponlticc* tiro entirely unirntating. and retain tlmir heat for 
a oonaiderable timo^ Tbe way to proceed ia to add a little cold water 
to tho itMreh.and to blend the two into n pap; then add itufliiiii'nt 
boilinir water to make a ponltioc of the required ouiuiKtenoe, wliit-h 
inuat be Hpci«d on linen in the manner nlmuly drMcribod. Sttirrh 
poolticoe soothe open canceiw, and allay skin cmptiono, wliun thoro is 
much inllammalJoo, heat, and pain. 

There aro mvoral ways of employing Qhareool as a ponltioe. It is 
noed to previ>iit diwigneeable odonra from font sores, and it is thought 
ftlHO to promote a healthy condition <if thi- tiitnntiic When employed 
for thin (luublu purpose, eh&rcoal is added to the ponltiec. A^ a 
poromt ponltice is hero roqninvl, brciul ia Itutter for the purpose than 
linMod-mcnl. A portion of tho charaoal should be noifornilr mixed 
vitb tbe bread, bnt the (greater part sbonld bo sprinkled over tho 
KnrfpuN^ of the poalti<»i. It in donbtful whether a charuoal jionltics 
ia grcAtly sopenor to a sliople breed poultice ; for tbu uLarcon] niatt 
soon otHuw to abeorb gMe«, and tbnit lose it« deodorising property. 
It may, perhaps, promote a healthier condition in the Horo. If tho 
objfs-t is mcrcly to prevont dixogreBable smells and to keep tho nir of 
tiie niom pare, the pbm pointed out in tltc flootion on charcoal ia to 
be preforrod, 

2 



8i 



POVLTICU AKD 



It iflU good practiee to itpriiikl« foni, rionghing, putrid Bores willi 
dry charcoal, sad oror the chumMd to plttce n simple ponUiov, or to 
tnak«i tLc jiiiuUiou of WL-I1-t<>s(it«dor of bumtbreftd. This tKAtmont 
iipjH-im lo hnitt<'n the snprvnilion of tliu Hlnnghs, umI to promol* ft 
Iiflftltiiier 8tat« of the tissneA. aad aiMy bu applied tu a boil when llip 
coro i» M'pantltng, or to k bcd-40i« while the Ulnck slough Mtill ndlicrCH 
to the lirinff tiMuw. 

Sonu: inninUin tliat a yeMt ponTtioci in nwful !d Hlougrhing Bora^ 
and that it prarents dp«iraclton of tho tiasoes, and ])roiiM>tM tbe 
aepoTftlioD of alonghn. Yi-hkl pouttiooN aro made to two wafS. 
Yeast and irat«r ma; be added to floar till ordiuaiy doityh w nwdv, 
and the doagh i« appli<.-d whilu fenn<!Rtalion is going on. In thi* 
oaw H is Bimpljr an application of " ri^inc* douKli." Tlui other way 
ii to amear warm jroost ovur lite mrtiice of a jiimpio bread poallioo. 

A carrot poallicv, which is snpposod to maku Houudti cltwiuir bti'I 
hi-althicr, is uado by boiling currobi till tli«; bvcomo quito aoft. 
maahing llMim with a fork, and spreading tho pulp on thu linen in ihu 
ordinurr wfty. 

Laudannin is sometiniM added to potUtieea to ease pain ; and it U 
Mpvciallj' oSiKtual vrben tho skin in broken. 

Solntiona of chloride of litae or of aoda may be add<Kl to poulticM 
to deiitioj oBenaive gOMui given off from unhealthy sores. 

In ecxcTOO, with reach inflammation and acnsation of heat. Dr. 
McCall Anderaon recomuicnilN a cold potato poultioo sprinkled wilb 
a small qgontily of abaorbout |)owilcr, containing cawpWr. Tho 
powder, a oaeful dnsting powder withunt tho poaltiu*. is composed of 
half a draehm of camphor, reduced to powder, with reotified apiril 
and throo drachma each of powderad tolo and oxide of line 

Profi«9ur Marahall nnploya an iodide of slAmh poultice to clean 
shnighing aoree. A jelly iN mode with two oottcaa of starch mixed 
witfa fix ooncw of iHiting water, to which Iwforo il cools abould he 
added half an ounce of 1ii(Dor iodi. Tho mixture is spread on lint( 
and applied ooM. 

Foroentalio&a by means of flannel wrung oat of boiling wat«r are 
employed for similar parpoM<« a* iioalticea. I'hey ore need for the 
■ike of their noietnn, bat especially for their warmth, and tJiey 
diBer tram pooltloea in being tem weighty, otnl therefore Ins likuly 
to inomue tlu' pain u( very tender parU. 'I'hu tta&oel is wrung out 
by means of a wrini^ made of sloni Uiwulling altAohed to two rods. 
The boiling wet HannnI is pLuml iit tlie wringer, which is then twisted 
n>nii<l tho Hannal rsry strongly, till the watrr i* tliomuglily iMjaeuxod 
oat. Aa Ihufhuuwl when Arst taken from liic boiling water is too 
hot to be held in tlm hamU, the wringer is useful. In tho bImoik-c of 
a wringer an onjiiuuy towel will answer fairly well. Wrung oa dry 



I 



roi'LTICCS KSO rOUI!XTATION3. 



85 



I 



I 



M poaxtble, thvuo fonicntuttonK nuiy bo nsed very hot without feoi* of 
scaldioff or blUteriuj? the skin. Tlic fnmi'ntntion itliould bo covered 
txitaidc with a pioco of mncintoitli, »nd tied on with bouilAg^B. j\a 
hot fomentations quickly cool, nnd Ixnng chi(;l!<r uud for thi; unko of 
heat, they must bo frpqocntly r*iiowod : vrben fiiialty rftiioved. llie 
Hkin must be carefully wiped dry, iknd covered with flannel or cotton- 
wool to [irovont catching cold. 

Fom«ntntiona, in alesti dirf^ree poult icrex, minx Hpusra in the int«mnl 
cii^na, w in intcttinAl, rrnnl and Intinry colic. In very extenuv« 
inHanimation fom«Dtatiooa are preferable, as a Inrgc pnnltico is heavy 
Mid anoomfortAbio. Thnii foraentatiDiu nro omployod when a limb is 
exUnBively affeoted with eryBipelas, or wheu the luumcK huvi; been 
wUIdy contasod and bnvo becomo inSnraod. 

Sponginff the face with witter aa hot as can be borne i* k very 
onful appiication in actio indnrnta; it will disporBO tho incipient 
apote, and limit the sise and hasten the matnralion of the niore 
nutnrcd onctt, nni] at tho tame tioui greatly le«9en fur some hours the 
redneaa of tlie eruption. 

Twenty or thirty drop* of Inrpentino sprinkled on a hot fomenta- 
tion of the nbore description makes a good counler-iniUnt, useful 
wh«n it is ncwdful to combine a stimnlnting with a warm, soothing 
notion. 

Sometimos it is dodnkblo to apply heat to a part of tho surface of 
the body, when at tlio same time it is important to avoid relaxation 
of iha tiisnos which moistnra would pradncc. In sncb cases various 
dry, airongly-hcated appIieationB ara nsed. Flaunel, atmoHt seorchod 
bofoTO the 6t«, or in an oven, is FomeiiiDCs «nipl(iyc<l, hot it speedily 
loMM heat. Sand or cbnmoraile flowers retain boat far belter ; tliey 
may be stnmply heated over tho lira or an iron pan, and tJion be run 
into a heated linon bag made for the ])BrpOBe, of sncb shape anil con. 
straotioa that the contents shall form a thickish and oven layer. 
Kauli nihstanoc possesses its respective advanta^s; sand, though 
heavy, retains heat; chamomile flowcni, though light, soon lose their 
warmth. A thin piece of Hat tile heat«d iu tho ovcn.and wrapped in 
Bannol, is light«r tluui sand, retains il« heat for a oonsidenble time, 
and is cnsjly procnrod. These applications are of great tervico in 
relieving th« jtain of BpaaUB. 



86 



TBE KWnaiSU. C«R8 Or 1CI. 



TUB MEDICIXAL USES OF ICE, 

Id ia freqnontlj- luod tn abstrnct lieat, to check btoediitg, to nllfty 
intUmniiUon, ami t« (Icxlrajr ncnnttion. h-« bnikon up willi thi> kelp 
of ft lanio neodlo into ^ajnu^nts may bo oiicl«so<l in » bbddor or tliia 
indU-rnbber Ing, &nl *r\\ii!cxiag tlio air out of tiw hug. After tilling 
iho bog nbont ono-tfaird of its capocilj, ita monllt Bhonld b* tiod on ft 
cork, BO ta to oflonl u purobaoe for tbc twiuc. Tho ice-InK i»*5 "^^^ 
bv iiila|>1cil to almost ftny shapoi ftiul fitted to tho in«qtiftlitioi> of th« 
bodj', oikI, if reqaind. nuty bo Awfaiorusd into ft sort of ntji fur tbo 
luiiul. 

This cap is appllod to tli« bead in tnbercnW and aimplo miminffitia. 
awt mny l« omplojed to nllay tho aercTe lieadaobo of tb« cnrlystosmi 
of aoutu foven. Som«tiiniHi Diq ice-bng tiiid ua the «pi|fftiitriam will 
finao tli« aeren) pain and romittng of chronic uloor, or of CAUL-vr of tlu; 
stooMoh. Unaoybo applied in prarigoof tbevulrw; other tnttt- 
mont, boirc^-cr, n gvoorally to ha preferred. 

Ill typhlitis and lyphuid f<.'vi>r od ioe ponllioo applied over tlio 
right •i<lu <if tbe lovrcr part of llio abdoined ia often li«ofu) in 
roliering i&Daiajnation and paJn. 

A lamp of ice inncrted into tbo otenu, or pnaliiMl into ibo rectom, 
ia noDtetimeB naed to arront utentid ha-morrhage after detivery. 

Ice is naed internally for » variety of pnrpoaaa. Sacking ice allays 
tbiral, and is vi-ry ^Tutetnl to fi-ver giationta. It la Ukewiae anokod lo 
check hlitsHng from the month or throat, atomaoh or Iurkh. To 
cltDck bleciling from Uie atomach nmoll pieces should Iw sirallowcd. 

The ooiutnnt nocking of ice ia most eflkncMnu in oomhntiag acnto 
inBammalion of the teonla or throat ; it aho ia yery bonaftoifti In 
tonailliliN, the «oi«4hroat of scarlet forer, and otlier ncnto MpM'illo 
tbnxt diwuMB, nixl even in dijkhtheria. It often proviM moat 
aoothing, albya tlie hmt and pain, and checka tbo abandant acorotioo 
of ninoUB, wbii;h in m lianu»ing from the mnatAnt hawking lutd 
deglutition it occasions. In di]lbtb<TiI^ and indeud in all iuiUininft- 
tioBS of the threiit, the good oflucls of ice, enpocially whan nsud at iho 
very beginning of tlie attack, are most luarked. 'Ilio Joe abonld be 
sockml an conttanUy an |io«aibhi, and be oontiuuod till tha dii aaio has 
birljr decliaaj. 

In the SUM way lea ia employod to allay the nanaea, sicknuaR, 
and pain of diaeaae of the atomach. 

leo may ba api^Iiutl to on inflamed and prolapsed rectum or 



I 



TBE UECICIXjIL DSB8 Of ICK. 



87 



nMriM, (o ntduce inflitmnuttion nnd iimdling, KO M to cniiljle theoe 
parts Ut bo retameil lo tlieii* proper place. 

Some Bp[ily ice to tbu )iiinid in doliriom tromniK and in llio uon- 
ralsioos of children. 

Thi! Appltontion of iv muAlI binddor or indin-mbbor h&g of tea 
will dull oT even nontralixe pain from iuBnnied piles, or nft«r an 
opcmtion for |iil«« or liaiaro of the aniu. 

M. Did»7 Etroni^ty recommeudH the local lipplicktions of leo in 
vorlikin ])iiin[ii] aSwitionn of the icwtiA, iw nonmlgin and blonorrhftgio 
oniliitis. Two pigs' bladders piirtially lilk-d wirb ioe are applied 
OBO und<T tho other over tbo testis, the ovighboariog porls bmng 
protected with napkins. Tlie pain in orohitis U at ftnt nttber 
inoreMcd, but loon doclino*, and in n few minatM altogathor 
C0WW. The continoona application of ioe bladdorR fur twenty- 
four to (orty-«i|fht hour* in many obmi pormanontly removes tho 
pain. If on pnssnre any teudentees remains, tlic pain will return, 
and the ioe must be eontinuod throe, or four, and even five, days, 
according to oircumatancM. On diacontinain^ the ioe, wet cold 
cloths should be used, to permit thu tiaanea to rotnm gradually to 
their normal t«mpemtnro. 

Two partA of fiuely-pounded ioe with one pcirt nf eomroon nit 
prodocM cold anIGolont to froezu tho tissDea,&nd to depnve them 
of Mnstbitity. This nixttire, largely used by Dr. Arnott, in con- 
flned in a ganse-bag, and pUcod in contact with the akiu till si^nsa* 
lion IK aboliKbed, and thi; sldu lias a, Icuthory frrl, nnd aMiiiuim a 
ahniBlcea tallowy appearanco. If applied too long. Ibid mixture 
may voaicato; bat thiti will not oocur under Sve. or nix minntca. 
This ap]>lii'att'iu is employed to pruvcot tlie pain of minor opera- 
tioos, lis extrai'lion of tbe toe-naU, and the opening of bImi:«x«m. 
Dr. Amott rec^onitucndH it in <thronic rlieuniati^ni, in erjsipola*, 
lumbago, and in wounds. In ohrauio rlwamutiiini it nhonld be 
applied to tlie diseased ji>int« for aix minutM; it shonld then bo 
replaced for a tdiort lime by pounded i<x, to prevent tltu ucunr- 
rauw of luflammatioii from too rapid a return of beat to tho tiasnes. 
As attack of InmlMgo may be ofteu cured by freoi^ing tbo sicin over 
Ihe painful part. Dr. Arnott oicwrtii thut when applied to wounds 
this mixtoro prcvcntt inflammation without hindering union by the 
tint intention. 

Applied for somo hoar*, tbix mixture destroys senKibility to Mioll 
A dt^reo that ehtoride of nine paste may be used in aufbciont 
quaulity to destroy tho tiiwnos to a (^onnidirrnbtii depth, without 
inducing pain or inflammation, itot other gpray, so (;ouvoi:iient1y 
and rapidly naod in tho manner introduciHl by f>r. Itii'hurdaon, is 
now gQDendly preferred for the porpoKo of freesin^; tbo tissuoa. 



88 tnvkL icR-iiAO— snsAb boi-water nut. 

A Ninglo ftpplimtion of ether R]im^ will ottca remove Inmbngo ; * 
etlior sprny lometimos relieree ficuttioa> and those fronUI b(>a(l* 
nobcs oummunly culled norvoaK, liriung from pithcr montol or, 
boditj fatigue. Frontal bcAdoche, dull and uniform in olianuiter4 
ttinting miuijr tlnfi, ooourring luit nni-oaunonlj ufur oscitement 
an ocnto illucss, sucb u erysipelas, a severe cold, or a Bond tJirnnt*^ 
often niccuTulM lo ether Kpnji bnt it i« gonurall; requisite to 
frcwie the skin of the forehcnd. 

Ad ice poaltice, t.e^Iiui;!)' brokcD ica in a thin india-mblier 1«g, 
14 » nwfnl application to tJie throat in tonsillitis, scarlet fever, : 
diplitheriB, specially when Ihii lymphatic glands b*oonie groatlyj 
EWoUen and threaten lo suppurate. 



OK TRK SPINAL ICKTIAG AND TUK SPINAL HOT- 
WATER BAG. 

1'hc prtifesMon is indebted to Dr. Cbnpmun for tbe introdnclioD oE, 
these applianoos, and for a rntionat explanation of their nctioii. 

Concerning the spinal ice-bag, Dr. ('bapinan mrs, " I liave proved 
by nnmorotts eiperimenta that cold applied to the back exerts nob 
onlj a Bodatit'o inflnenco on the spinal cord, but iJko un tlinsc 
QsrroQS centres which preside over the blood-veMcJs in all parts of 
the body. The nt<iifuj operandi of tliis inflnvnce on ibose oenttes^ 
and its effects, may bo thns slated: '1h(. It partiall; peralyxes 
them. 2nd. Uy means of the partial paralysis UinH effected it bwenH 
the nervous cnnvnts in tlic raso-motor nerves enierging from llie 
ganglia or nerve centna acted upon, and slimnlating the muMular 
fibres SBrronnding the ftriories inflnencod. 3rd. By thus lessening 
those currents it lessens the uontraetUe onvrgy of tlir mnscolur baniU 
of the arteries to which those correntsflow, nnd by doiiiKH'faeilifntea 
Ihu ililnlutitin ef thone art<Tricji thcmsolveiL -hh. l)y Uius indneing the 
oonilitiun of oH»y dilnlabtlity in tlie arlerioa acted upon, it ■.■nablos the 
blood which (lows in the diriMtton of least rtsistanoe, to enter ibam 
in gnater votnns^ and with gmter force than bofero.' " 

These efleets are aoalogoas to tluxw olrlAiiwd by Claode Bernard. 
On dividing the syin|MthelMi nerve, he found that the vessels of the 
parts supplied with this nerve bei'ame dilato<l and received an in- 

• n« tNln asJ Mifsaa •( tliv biwcIm al tk* Wk In IsetUcs ns; dWn be iartSM- 
isDSM*!; N«««ed hr rasnlsf a bmiU* as Intb or nan isu tW palnhl part ; wWa (he 
iNshlf* b drabla, Ibli sIbM |iaialiB (ixnttita AtmM be ptrlsraad as bolfc (Uw *t 
tb« MoL IsHiMd siMHt U>a eaone «t 1h* wisUt ntrts, lbs mkO* sowilha w sbrds 
IsMsst umI M*rk(4 rvllaf, ana la iwtj tkiwOa (omb gf MtalUs. TUi litUiMnl bdMJ, 
sMHsUsM*. aa 11 by m»^ ntm ■•*«« asd koi'Maadliv osaa. Tbe t»—t» M aa 
InlMnpUd edfsaif esmat elU ifstdUf nlisn IsMkn*- 



snXAt. ICe-UO — BP1XAL nOT'lVAISR vxo. 



89 



CT«fu)cd snpplj' of food, villi a proportionftto an^moDtAtion of thu 
vita] properties. Cluipman ktlth tliut, " ThoBU phenomeoa which 
Profcmor C. Beni&nl prodncod m the bead of an nnimnl hj section nf 
Om ovrviniil K^inpftthetio t hn.vu indnci:il in the head, thomx, &hdo> 
mon, polvifi, and fotir oxtremitieB of man, b; the application of ico to 
tlw diDtircut ])i^ts of tbi> back." 

To SDpply an increased nffliix of blood to tMy part of th» bodjr, 
Dr. Clmpni&n npplii:« tho ico-luiK to rarioiis parttt of the ti)niie ; to 
the nock and between tho shonldL-rs, ivhoD rooro blood is seeded fur 
tho bi-iul : t<i tbu upper pnrt of tlio baok, for tho oheiit »ud arms ; 
to tho lower part of tho bock, for the abdomen, polvis and logs. Dr. 
Chapinao sajra : 

I. "MuKiilar taiuicn it iimiairhed bi} tke applteati9iHifie$*dQHf 
lK« tpine." In Hnpport of this ilHlemeut bo aiiaort* Uiai flia laa^baf 
will prevent tho crninps of dlarrhoia and cholera, and in tijwfnl in 
latTDf^Buitu) striduludi, ohorea, totanuH, intiuitile convul»Jona and 
dpilvpsjr, and " io prolonged mnscalar ri^dit^ dno to oonte or 
chronic disorder of the nervtiut uentrvii." 

II. " Sentibiliti) it UttojcJ ttij Ihr. apjilieation of wild atony th« tpiM. 
This is proved conoluaiveh- hy my oxpurionon, whieb lias boon con- 
wdvmblc, ID tlio troatmontof nonralgia." 

III. " Seention it letteneit by il>e application of old along thv wpint. 
I liavo aunrod mysolf hy esporicnco in nnmn'ous caaes of the truth 
of thia propoeitioD. Morbidly eoccevatve sweating, broncborrhnm, tho 
exceMiro action of tho alimoiitary mocoos membrane ootislitutiug 
llio chief canao of diarrkcea, exceaiitre action of the ki<lncj«, leu- 
oorrhma, and spcnuatorrhcea, I have rcHtrained over and orer again 
b; cold properly applied to the a]>propriate part of the Npino^" 

IV. " Tiw poriplt4rrat eiTeulation, anJ euiuisi]uiiBH>/ bodily heat, it 
inenated bjF k« apj^ied along the tpiw." ile uarnttcn the fullowini; 
Bingnlar caacs in conHrmation of thi« proposition ; " A woman, a^d 
sixty, who for more than twonly years had alwayx been cold to tho 
tuuch, oven ovor her shoulders and bosom, thoogh she waa warmly 
cli>llied ; and her feet weru hnbilually and cxtivmoly coId.^Aftcr 
nsiog ioe during three weeks, aevaral hours a dity, the whole surfaea 
of tho Itody, iiiclnding her foot, bocRmo wonderfully warm. She was 
oxtromely astonished by theinoreaae of the t«mpomtnra of her body, 
aa w«U aa by tho >abH)d«nco of ovory symptom from which sho hod 
■nJI«red for so many years ; and when sbo called apon mo a week 
after the treatment had ceased, her Dowly>acqalred increase of 
genoTal oiroulation, dcnotod by hor incroaeod warmtli, Hlill uontinued. 
CtM 2 of this series affords a reroarkable proof of tho pr»p<Mitian in 
qn«etion : Tho patient, a mao ag«d fifty-six, who seemed nearly 
Hoventy, suffering from paralysis, epilepsy and other gntro tronbles. 



90 



SI-ISA.L UOT-WATBS BAO. 



oonaplvncd that he wm almtjrs 'cold all over'; that h« suffered 
Mponaltj from coldnMB of the hoi, even in the hottost vnmtlicr, and 
Wss oUigud, ns hU vife aoid, ' to nit n«ar tk« 6re in aummer.' WiUiin 
ODB week aftor tho tituitmiint, which was cootinnod thren munUm, 
UiU patient liad bwome vnurm all over — cupucially the fei-L Within 
ft month ii« said, ' 1 feol u woll as possible ; l>nt vciy hot, vprjr hot.' 
In lhi« COM, otter the ioe hod been left off for aome d&VH, the patient 
booomo cold ogftin." 

Dr. CliapiDftn BBaarta that ioe applied alonj; the lower dorsal and 
lumbar vertebnn, bjr inor«Ming the amonnt of blood mpplied to ihe 
pelvio oi^gans, promotee meostr nation, and will eren reetore tlie rap- 
prcRMx) monthly flax. Tho tco-bng, bjr increasing the flow of blood 
to the legv, proves rorj eomforlable to persona hamnrtH with uold 
fMt i and I hftvft often soon the f cot become comfbrteblf w«rm a few 
minntiM after tlie application of the too. 

Dr. Chapman ae>ort« th^t ic« applied along tba spine ie extremely 
niief ul in cliolem and tetaons, in eea^kaew, and the vouituig of 
pregnancy. 

THK SPIKAL IIOT-WATKU BAG. 

Tiir. phyHiologioal cffecta prodncod by h<?nt to Ihe spine are, aa might 
bo inferred, the opposite of those indn<-od by cold. Dr. Chaptoan 
mys that, " Ut. Thn tfinpcrsturn of the sympftthetic ganglia being 
raised, tlw How of blood to lh«m beoonue morooopions, and the fnnc- 
tiona conaoqnontly become mom unergotio than before. Snd. Their 
nerrona inllnenoe passes in fuller and moro powerful streams along 
Ihe nerves omorgin^ rmin Ihom, and minifrin^ over tJio blood- 
vnsiiol* which tbey oonlrol. 3rd. The uiUKctilar bands snnoniiding 
thoee T«B«)l8, slimnlated by this increasoil nervoiu afflux to ountraiit 
with mora than tlMtr ntnal foree, diminlah proportJonaUy the 
dlaoieter of Ute reesela thomaelvea. 4tli. Tli« (liamaier of the vraads 
being tfana loMened, the blood flows through them in less volnBie 
and with leea rapidity than before : iiidcoi!, it is probablo thnt, white 
the Dorvou* ganglia in qaeation an nuulo to emit thoir maximum of 
(Oernry, many of the terminal bruaohM of the blood-vamwliiaotvd njion 
beooae aonplotoly eloacd." The temjKiratare of the hot-bag akould 
not vxnml I9U^. 

Dr. Cbapmnn employs lioftt aloiiR the spine to dontraol the blixid- 
tomwIb. and statea that if propnrly appliud, it will not only laHMn 
bat will arrMt tho moostrnal flow. He aawirU, aa Um resnlt of hia 
oxperienm, that it will nrroBt menorrhagia and biMding from the 
noM and lunga. In bliM>ding from the noae or Innga, the hot spinal 
bag matt W applied along the oarvioal and apper donal vortebrw) 
in menorrhagia, along the lower dornal and lumbar Tcrtebrm. 



lyrzRxiL USE or wateb. 



91 



k 



I 
I 



THK INTEEXAL USE OP WATER. 

A nil romftrlu ma; be made licre coDveoientlf on the drinks Iwgt 
>(iit4xl to fever patioots. Tho importoiuktc und distresaing thirat 
often CMUM mnoh nwUeasneu Mid imtabilily , whilst thcAu in t)i«tr 
tnro often tnoreaao the fovm. Tboroforo, the urgent tliimt luiul be 
allajred ; bot i( l«ft to huDitelf » patient, to utiato bis craving, will 
always dn'ak to cxocm, which is Toiy liablo to derange the stoiuaclL, 
imjMur digctition, produce flfttulence, and ev«n diarrhoea. TliL-or; 
and •xperience both show thnt drinkii mude Bli^btly bitt«r aiid 
•omeirlial ncid >tako thint most effectnollf- A wonk infuKivn of 
eaacarilla or orange-peel, aeidnlatcd alightly with hydrochloric acid, 
was, with Oravw of Dublin, a favourite thirst-qneUing drink for 
fori>r palienta. Hospberrjr vinofpir ie a uneful drink. Sacking ico is 
verj gmtcfu!. Sweet fruite, allhoagh at tirst aifri*Dab)(j and rafnuih- 
tng, mnat be takeu with cato nnd muderalion, for the; often give 
rioe to a dtugrseablo taate, and are apt to produce flatulenoe or 
diarrhcea. There is no advontngu in " curtailing beyond a modeinte 
dcftrvo tho amount of water drunk by diabetic patiunt*. The urine 
and sugar may by this means bo leoaened, but the geneml diatrass 
inortosed " (Uoberte). In tbe thirst of diabeto) Proul recommends 
Icpid drinks. 

Rinsing the mouth with water as hot os can be borne will often 
rclicre and indeed souelimctt subdue toothache, though occasionally 
oold water answers better. 

Water ia neovasory both for the digestion and solution of food, 
but an insofGoiont as woll as an oxooesiro qunntily are alike hamtful. 
T)iv character of the ferinuntations, it is well known, depends on the 
amount of water pnwont ; for inslancc, with sugar, if there i» bat 
little water present, no fermentatiun will takt' place; while, on the 
other huitd, with excess of wator, acetous, insttiod of %-inQus fcrniun- 
totion, will be set up. It ia more than probable that the i^uaulity 
of water taken with the food may, in a similar way, affect the 
ehau(^ which it underguas in tho ntomaeh. This much is certain, 
that tho drinking habitually an excess of water with tho moals often 
ajgigravates dyspepsia, and, on tho other hand, indigestion appears iu 
•om« casM to be connected with an insufficient qnaotity of Quid. 
Flatulent dyspepsia is often traceable to oxccm of drinking at raeal- 
timos. 

Too much water taken with the food impairs digestion, simply 
by dilating the gastric jnioc, oud so weakening its eolreat power. 



92 



tmCRNlL CBS or WATSII. 



Tho popular i<li» proree tc bo correct, that drink slionld bo taken 
chirlly nt the end of the meal, when it xerveN miinj' uxcftil pnrppsoii ; 
it then aids tlie pas8>tg« of the peptonca from the tut«iiili»e§ to the 
blood, nnil «a favonni the conLiuuiuice oE digMti»n, aince it is hold 
that tbeae peptoDM 1und«r tbnl proc«M until Oivy ]maa fnm the 
oftnaJ. MonMrer, indigetitible KnlMt«nco«, onlj^ portiiUl; diaKilTed, 
are carried by ibe fluid througli the pjlorns into the iDtestinea, and 
thon sahi«clwl to farther digcttlion or arc vliminatcd with the 
nwtioiu, thus removing a souri:e of irritation from the stomach and 
int«Btiiuiii. The prevailing, piirvorMi modem fanbion of tee-drinking 
a sliorl time before dinner cannot lie too Btrongly condemned ; the 
oarlf t«a, if penniitsihlo at all, iihonid bo taken at least two hours 
lwfor« dinner. 

I& our dcitiro to avoid the inj^tion of too much drink, we mnut 
be oarefttl not to err on the side of nodue abMioence, for it has been 
shon-n that a proper amoont of water favours the Morction of the 
putric juice, and promotes the paaaago of the peptones into the 
blood. Ice<I drinks at mcul-time are often harmful bj' conatrinj^ng 
the reHneln, and preventing the seoTotioD of the doe quantitj ot 
gastric jnioe. 

Cboroel deacrihed, and Dr. T1i<mi«r);^d rec«nt]j narrated, aomft 
OMOa of a form of <lyBj>i^psia, c&ltud by him " indigostion of flatds," 
ohaimctorised b^ uneasineai after drinkinf;, and a spta&hitig noise 
Iward on pereuMi&g th» stomach or shaking tho body, oven when tho 
patient has taken no drink for some bonni. The beat treatment for 
thia curiouH indi^tion is not to drink till somo time after a meal, 
and ao litllv as is ooropatiblo with comfort. 

After takin;; an emetic warm wa(«r, or varions infoaionn, us chamo- 
mile tea nnd mucilaginous drinks, arc i^mplofed to pro rootfi vomiting. 
Kor this jiurpOMO, the qnantitj ot fluid taken sliouid not he too lar^v, 
otherwise it distends tJic stomach, paraljrxes its mnscniar walls, and 
impodw, instead of promotes, vomituig. Half a pint to a pint ia 
nflioienL 

The action of water iu the intestines is similar to that in the 
stomaoh, and its presence is necessary for llie alisorption of the 
digested snbstanccn in thi« part nf tho canal. 

A glass of raid waiter, taken early in tberoornintr, acta to aome per. 
■MM ns a inirgativD. The canker; lait<<, liot sensation in the month, 
aad httk of appntJlo for breakfaat exporionoed bjr munj porsona on 
wnUng is genmvlly removable by drinking half a tsmbler ot pnre 
ooM water half an bnar l>i'rort) ihiit mual. 

A gloM of i»ld watL'r, taken immediatelj- on loanng bod, promotM 
tho reaotion after the " morning tab." 

A toofrso iadalgonoeinflntdsoftoniBOnuMorkeepivpdlarrlitBA. 



nriBBSi'iL DSB or water. 



93 



k 



Froo wator-ilrinkiiifr inoroMos tlie n-ater, bnt not tlic toluls, of tbo 

Water reoditj- passee into ths blood, bnt witb certain limitations. 
Wben tbe syttcm bna undergone fjreat loas of water, tbia fluid in 
nlnorbed witb much nviilitr, and iU rapid pAMngo into tbo circala> 
tion may niatr?iull]: aff<ict the blood ; tndood, tliin tudilun and copiouii 
inflnx of water is said aoinetiines to destroy cattJe by tbe rapid 

itruction of tlic blood-corpnsclofl by OBmoi>i». Hut vihca tbo 
^jfiBonnt of wat«r in tbo blood ia already ample, tUe absorption of a 
furtber quantity from the stomach and intostiaM ia much diminutbcd. 

ExccM of water in eliminated in variouit ways. Some, aa we have 
said, passcB oS by tbe int««tiac£; Bome is thrown off by tho skin and 
Innga ; bat moot ii cxer«t«d by tbo kidneys. In mix hoiini tbe obief 
jMTt is eliminated, though nfl«r strong ozorviso much water ia 
retained in tbe muiwkii cNiuiidurably longer. 

Copious drinking exerts a further action on the nrine than that 
jast mentioned ; for not only dooH it increase tbo urinary water, but 
it alao augments tbe other constituents as urtja, pbospboric and 
Kulphnrio acid, and chloride uf sodium. Thu angmentation of tliuHc 
constilnenta, with the exception of tho chloride of sodium, is pcrma- 
nont, but witb ivspuct to thia nit tbe iocronce is only temporniy, for 
after awhile its amount falls belov the quantity excreted in health, 
aud thtM tfaa pr«viou» incrooaa ia balanced ; and water must, tlicno 
(ore, in regard to common salt, be considered merely a temporary 
eliminator. The com ia difforvnt, however, with urea, phosphoric and 
snlphnrio add; for water.driukiuK iudncea a fixed increaao of tbow 
sabstancee, giving rise not only to rhoir iocRHMed elimination, but to 
tbiiir incmm-d funuation, which can happen only from angmcnted 
disintefn^tion of sabstancee containing nitrogen and suljdiur. Did 
water-drinking exert solely a diNintugrating influence, it woald load 
morelj to a loss of weighty bnt eimultnneonsly with this rapid 
diaiDtflgration a corresponding increase of a«iimilHtion takps place in 
tbo samo tisanes ; whonco it happens that water, taken under certain 
precanttoDS, may increaw! both tionstruution and destruction of tissue, 
and so act as a tmo tonic, improving the vigour of body and mind. 
Tbeae considecationa iugg«9it an cxplanalinn of tbo benetit often 
derirod from tho "watAr treatment" in hydrupatliic ins lit u lions. 

Tbe effect* of water-drinking vary in different pcntons. The 
disintegration is greatost in weakly perwins, ou whom tbis prooeas 
may prodnce almost a fclirito Htat«. Di«int«gmtion is greater in 
'rhildrpn than in adaltn, and jjreater, pcrhap*. iu women llian in men. 
A high tomperulure of tlio water, or of the extpmal air, increases 
disintegration. Bodily exercise produces tbe same cBect (Parkcs en 
ISrinc). 



Kxtatxk. 



ON ENEMATA. 

IvJitorimra aro niwd for a rnrictj of parposea; toproogre evacuations 
of the bowclti, to mslrain (li&rrbcB«, Ui mko p*iii nlwnt thp rtif^on of 
tho pntriH, to doctruj womm, to iolroduoe medicines into Um (general 
i^atom, ftod liuitJj, to pass nutrJtiru iiDlNitaiiM^a into tho raotutn, in 
caaee wh«n) food oannot bo t»kon bj tiio etonaach. 

For Mkoli of these porpueea eerlain points miut be attended to in 
the ndninistrntion of eoeinftt*. 

7iral> concomia^ tnjoctioas nnod to nliore the howds. it muat be 
cleori; Dndentood tb»t au encnta seldom acts bjr merely waxhin^f 
vmj the fooea ; for it acto offiHontlj when the feecal matter ia lo«lg«d 
high up tha intostiiiM ; erm in the tramtveroo colon or mdohdi. Ab 
injection prolmbly atiinnlates the whole inteittinni tract to more 
vif^rona porifitaltic notion, hj which mennn tho content* are propelled 
abmg the eanal, and linnllj expelled, the injeotwl fluid distvnding the 
lower part of the lar^ got, and ko exi-itintr tho vermiinibr aniion of 
the intOKtJneii far beyond the point rcocbnl bj tbo Hnid. Thv' objoL'l, 
therefore, is to diatand the rvctnm and tJie adjouiing ]wrt of the 
intottine, tmt an oncmn oonrtanlly faiU bocanne not onongh flnid is 
inlrndncod (o excite contnotion. It is neoessary to introdnce a cin- 
gidemMe ((unntity of fliiid. as tnnch Kt two, throo, or «ron fonr pints. 
Aiij one who, for the tirxt time, witkont due obsen-anoe of oertata 
conditiooH, att«inpla to introdace a copious iDJvction into tha roetum, 
will in nil probability fnit. 

When a copious injcptioD is to 1>o fp'^O' 1^* patient should ho 
plaiKrd on Ihr left eidv, and the fluid must bo slowly pumped into 
the motnni ; nfter a variable, hut nt>unlly a short, timo, the paliont 
nonplatiM of inability to retain more, and sntfoTH from colicky pnin 
in tlw belly, and nn urgent deaire to emply the bowels. The pnmping 
muat now ho intertnitted for n whilr, and the patient directod to 
prpvnnl llie eMrajie uf tlie fluid ; but if he is unable to oontrol the 
sphincter, tliu ndminifttmlor must lielp him. Thin can be ilone in 
anrpml wnys, «aoh having for its object tho streogtbeiiing the oon- 
traotioD of the aphindt^ir. TIm ttimptest, bat not always the moat 
mcoosaful plnn, is lu flmdy support the perinwam and streotuna 
around tha anas, <iil her wilh the bars bond or with the aid of a folded 
towd. Sboald this support prove incffaotual. which is often tho case 
after a ooaaidmhle quantity ol fluid haa bean iatrodncwd, further 
aaaisUnco is afforded by passing into tko reotnm, alongsida tho 
noulo of (ho en4fma-pip«, one, two, or arun tlmw 8ii([«fai na ciiwon* 



XHBIUVA. 



95 



I 



utanoes tatt}* reqaiiv, uid proasingr them witli tim nosslo sirongtf 

Bipirard. Slimalutcd in this ivnf , the uptiinctor Gradr graapti tlio 

Ktigera, and effMluallf prevent* the escape of the fluid ; indeed, with 

ItliL'Ko prcontions. almost nnj tunonnt of fluid maj' bo puuiwd into 

Itho ittlwtiuoji. From iimo to time the patient will comjilain of 

^^pini; pains and an opprMsive degirc to go to ctool, when tUo 

pnmpinf; Hltoold bo nlAf I'd awhile, and reoommenced as soon as these 

nymptoms pa#s away. The operation over, tlm patient mast be 

directed ti> lie quito qaJvt on the left side, and, if possible, to retain 

the flnid for ton minutes or mora, so as to onsnro n more active nod 

tborongh c-ontrai:tion of the bowek. 

It need scarcely bo meDtioned that if the rectnm or lower part of 
the largo intestine* l* the seat of uuicer, or i* diai^aaed iu other vrays, 
OOpions injections, and tbo iDtrodnction of a long tnlic, arc itttcndod 
witli dan)?er. 

Stinietimo* the ractum and lower part of tlie gnt am blocked to 

Idistension with fniw*, %-ainat nliich the injooted fluid Impingns, and 

rflnding no pnawg^' it of necessity flows back through the sphincter as 

Inst as it is pumped iu. One or two ways may bo adopted to foioo 

such a hlo);kiute. A lioUow tuhc of somo inches in length is passed 

throngh the impacted faecoa, till it* free extremity rcRchciv the 

sigmoid flexure, or even higher. If the tnbe i* passed through the 

oocumnlaiiou in (lie iniiitine, the injection ean cattily proceed. 

Should this manamvro fail, and the need is urgent to obtain on 

sraottatioa. tlien two or tlirou Gngera, accordiug to tho yidding of 

the Hphinotcr, aro to be introdnoed in the rectam to wiUidraw tlio 

fsKM. This can bo oonily aecompliiUied if the fane* are hnid and 

iSna. Obstinate constipation ot thin oharaoter occurs moat commonly 

lin diabetes. The hard and almost stono-like faeuos can easily be 

|.withdrawn by tlie Angers in the manner described; and much more 

nay bo withdrawn than is contained in the rootinn, for nitltough the 

intMinea may be unable to force llie hardened f»06R throngh the 

sphincter, they aro ({nile capable of propoUing them into the ruirtun) ; 

^_ eonssqnentty a« fu»i asthofn^ou* aro withdrawn fresh supplies tire 

^■propelled downwards within easy reach of the finger*. 

^B Various fluids are emplDyed as cnomatn. SometimiM simple warm 

^rirftter or gruel; at other times, to one or otherof theao t* added 

soap, turpentine, or castor-oil. When castor-oil or tnrpontiue is 

added to the injection, soap and gruel are gencmlly employed to 

help to snspend these snhetaaces. Itmuet berocolloctod that castor* 

oil and tnrpentino are lighter than water, and will Uont on its 

I eurfiu:e, to that if the oil turpentine is added to the Rnid to bo 

^■iojcpted, althongh Uio whole may he well atirred, yet, a* tho injoo- 

^■lion pnxeeds, the oil rises to the sarfaoe. As the tuhoof tho syrtngo 



1 

I 



90 



BKBIUTA. 



livH at tlio bottom of tbfi v«>k*cI, the lower sUntam of tlio liquid ia 
first injecl«d, and mnch of Uie oil or turpentioe eitii«r flonU on tlto 
snrfnco or Ktiukit to ihu ftidcii of tbe uwiil. whilo the (tnutll pi>rLion 
nltinmtely injected oporatm oaly upon the rectum and the noigli- 
tNinring intCKtiDe*. Tlie object nhncld bn to nuko tho oil or the 
lurjieutine, as the cose outj be, rise us kiKb up tUe cuial u poesiUff, 
M> M to bnthe and inflaeoco the macons lining of the Jnt««tinM. Tbe 
oil or turpeDtine, well beaten np vritli throe or four ounces of 
grael, or «oap and wotor, ihonld bo firat injected, and then ihfl 
water ia to bo pumped in, ao an to force tho oil fnr np tbe tnleatinal 
cnna). 

What ithoald be tbe tcinperatnni of an injection P Tepid fluid ia 
generaltj nud, but mow conaidor tliat an injection difiering in 
temperataro videljr from that of tlio hndj nct« mora eneijcetioallj 
on tho tiMncH, and cxritos the tntestinee to more rigorotu action. 
Thus cold or hoi water uia; be naed, and ver; cold wnter may ho 
injected wilhoat inconveoionoo, uu) witltont the patient's oogninuioo 
of it« temjiemtnre. 

[t ia ansdviaablo habitually to nse warm eTOonant enemata, lest 
m torpid ixindition of tbe intetitinai enitue, and ho ultimately render 
tlie constipation worw. 

A« wu have said, large ([anntitieii of water aro employed U> nnlood 
ifao bowel* : but tfaiR in not the eolo nse of a free injection. If osnl 
comfortably warm, it in very »ixitbing to the intontinc* and to tbo 
ooigbbonring organs. Tbna, warm injections will often much mili- 
g»to the pniu of cancer, cither of the intcrtino* or of tho adjaomt 
ofguu; injeotioDJt, also, often greatly relieve the very distresaiBg 
■Iminin^ dtvite to craeoale, irilbont any riddance of fvyo, which 
oocnr in inteetinal cancer. Warm injections soothe tho pain of 
cystitis, proalntitis, abeoeiu of tlio proststo, aod pelvic and at)da- 
minol pains gMwmlly. ( Vid« Opinm and BelUdonna.) 

In Home instances of aappn-iision of urino copious injeutions 
appear to act beneficially. 

Injections aro often aucoenfnl in rustmining ufaatinato ordangen>as 
dtarrhoia. It is by no moans noooMnry for the injection to roacli 
that part of tbe intestines Dpon wliicli the diarrha« depcncb ; for, 
whvtiuir (ho misohief is sitoitied in llie small or targe intestines, the 
injeelioa is oqnnlly benefloial, owini;, ho ilunbt, to a oIom Hyn)[inlby 
lietwecn tbe diffenmt parts of the intostim-s. so that an imjireBsion 
undo on one part is oommuoicnted to anotlMir. In rostraiiiiatf 
diarrhoa only a small quantity iboold be injooted, olheririsB Um 
intestine is stimulated to cuutmcl aod expel tho ominio, whm it 
•buuld be rclainod as long as possible, in order tbe more uRocttinlly 
to inflDeoce the bonvls. An injection of an onoce, or ni most two 



I 



EKBtUTA. 



97 



I 
I 






onnccR, ta aofficient far an ndolt; nnd it mtiy be repeatc-d aerend 
timen a day, according to tlic urgi>Qcy of th« diarrha<a. 

Tho lantsriol luad ia miolt ouematn in storob, builcd or nvw, of tbo 
oonsistence of ortt&m. and at n. (emtjornlnro of 100^. An injecrtion 
'Simply compoiwd of ntAivb pniwa (TfTt'ctunJ ; but iu tutringijnl lacidiu 
tin Kcdon may be mucb heightened by the addition of aomo dropa 
of lasdannm, gmdimtud in (innntity oucordinfc to tbo patii-iit'H n^ 
And condition. Tiio addition of some acotatu of lead or snlphate of 
copper reodors this injection mora a»t^ingl^nt. Those injectioa* are 
inviUnnblo in ooaea where delay U death. They will tavo many a life 
in the cholentic diarrh^sa of children, wliicb ho nipidly provux fatut 
QolcM speedily restrained. Tbo diarrhoMi of typhoid fever, which, if 
exceasiTe^ adds extremoly to the patJcnt'n danger, ytcldji tjpincrully to 
(fawe iojeotiona, bo, nsoally, dow the diarrhoea of phthisis. 
I Injections aro commnnty QMd to destioy thread-worms, which 
infe«t the rectum and the intestines iu its immedinto noighbourhoodf 
hut occar in no othrr part of tho canal. A» tho object of the injeo* 
tion is to dcatroy thesu entozoa, a quantity of ftnid shonid Imi 
employed sofficicnt to reach a little higher tlian tho rectum. For 
adult half a pint is adequate, and for a child, 'of course, Icsx. 
To tho water inj«;t<!d various Bolistmiocs can bo ndddil, a* oommon 
Mlt, tincture of scschloride of iron, lime-water, quajuiss uud various 
otlier similarly acting vcmicides, witlt the objoct either of directly 
poisoninf; the worms, or of destroyis^ them by coagnlatiD||f the aibn- 
minons stmcturirs of their bo<licK. Injections An always successful 
in removing worms, and thus aSordiui* t«mporury rdief ; butit nusL 
always be rocollocted tbnt the morbid Ntatn of tlic tnncous coat of the 
inloKtinCii, favouring the production of worms, must be remedied if 
permanent roliof i« to Im obtainod. A tcospoouful of salt, or n 
drachm of the tJactnre of stool, to half a pint of water, ia sutD- 
ciently strong to effect the dcidruction of ihuiu deJicatoly- formed 
UiimalH. Solutions too concentrated must not be iajocted, otberwiHD 
iBflBBastioii may occur, porhajM suvcre enough to cause sloughing 
is tlic Motum and margins of tho anns. 

Nntritiro cnAoiata are employed iu stricture of tho owophagufi, or 
when tumoora press upon this tube and render swallowing impos. 
sibic, in iior»iNtviit vomiting, nod in painful diseuHM of the stomach, 
like chronic ulcer. A nutrient enema should not exceed three or 
four onncM of btand, iinirritating m&terialt otherwise the lining 
mombrane of tlie rectum heeomes irritated and inHamcd, a cimditinn 
adverse to abitorptioiu Xr. Mnrcns ^ock advises the addition to tho 
injection of pepsino and dilute bydrochlorio acid. Prom experi- 
ments on doK», M. Bauer linds that the large intostiucs fi-oely absorb 
pvptonos, but that pure soluble idbumeu ia not absorbed, though it 

11 



98 



ACCPOXCIUBE. 



is taken up readily on Oie addition of »a1t. And nolntinm of 
Blbnnuni, u ment dimolrcd in wenk hjrdrocliloric ncid, «ro oUo fmdy 
abaorbed. Fata and atarclies iujeot«d into tlio lai^o ttit««tiii<! failed 
to KoppoFt life for nnj roiDiidomblo tlmo. It snmclimc* Imppons 
that tlie reotxim nill not retain even four ounoea, and thin inability 
i» more linblo to ooonr aiUir injootionn havo bocn continnod for soms 
timo. Befon (^ving a natritive injection, it nuat bo uoartmined 
tlint Iho roctnm is not filled up with forces. 

Dr. W. O. Lcnbu eraployx the pancreas of tho ox or pig m a far* 
Bumt ; ODO part of flaolf-icincei! piuicroas being mixed with threo 
pnrb of aumpod mistt, rubbe<l wall together with warm water, m> 
tbftt the mixtnra ta etuilj injected. Fat, not exoeudinK ouo-eixtb part 
of the m«at, may bo added. This injection ia retained from twdv* 
to thirlyaix hours, and the atoola nftt^rwardt gcnentllf poaaeas aa 
ontinary fjocal charaotor. Bjr experimenta on dogs, Dr. Lnnbo han 
proved tliat by niuuia of injeotaona a uonatilorable qoantit j of nitrogen 
can tie tnVon np into the tjwUxa. 

Astringent and NtimnlAting injeetiona, oompoaod of a pint of water, 
and eontnining t«n to twenty gmina of anlphate of copper, or com- 
•ponding (juanlitioa of nitrate of ailver and aalphato of xiu«, )>rov» of 
([reat servico in nwtrnining the tronbloaome straining diarriicm of 
ohronio dyaenterj. In the earlier atages, aim, of dyaenterj, lutfto 
enioUient enemnta prove niofnl, ci>p«ctally by removing the fcvtid 
diaohargea, and aoothing the inflamed niiiooaa mombroue. In olJier 
aectiow, whilst tnnting of individnnl draga, various additional uses 
of onemata are pointed ont. 



ON ACCPUNCTDKB. 



AcVPDXCTrn ta a very ancceaaful mode of treating lombago. It will 
T*t«lj fail to afford raliof, an<l in the mnjority of oaaM it will ooro at 
oneo. though the Inrabago haa laartod a week, or even three weeks. It 
avocvoda btoit by far in typical caaoa of Inmliago, when Iho loin mnaalea 
of bothsideanra affeelnl. and iho pain ia moataerereon a to-and-tro 
moronent. 1 liavo treated a large nniDbcr »f such c«s«e by acupuno. 
Inra^ and End that it gima almoat Jualautaneoua relief. U ia gcno- 
mlly anSoient to nin the aeedle tinoe deeply, Mty an inch, into th« 
BUolw on MHsk rid« of the tpine, over the wal of gmaleat [*ia. 
rorlMtpa It nay be lwtt«r to Imto the n«edlea for a few minntca 
atieking in the hack, but I liave hitherto found this |>rooeeding an* 
neow— ry. 



I 



ActirmffTCRE. 



99 



V 

MEvi 



Gennmllj, when tlio Dcndlce are first ivitbdrawn. iho patient says 
the pain is itlighttjr eaaect, but pnMcnttjr it (li-civ«Fn» nipidly, aa<l lu 
tfaroo or foor minatc* it is cntirol; gone, perhaps a little stiffnws only 
TvnuMiiini;; but evvn Uiia may bu absent. Tliu pulicnt. wbo jiul 
before could not bend in tho slightest de^reo vrilliout the gmteat 
pwn, who could not poimilily Htoop to touch lii« tocN, now bcndii 
backwards and forvrni'ds ivith the atmoat eaao, otUm with a loolc 
of iwtoBifihinont mingled with inorudnlit)-, im if tho euro ware too 
wonderful to bo tme. 

PftnutiKntinii of tho buck is in tnjr I'xpcrionoo ulraost ns RucocMfol 
oa acnpnnrtTire, thouRh tbu pain ruorw frequently i-otunia than »ftor 
ncupmichtro. Under ciUK^rtr<'ulini.-nt it Homotimcs happens that after 
aerfind honm of r«Iiff the pain returns, find a renewal of the treat- 
ment tnny either bo almost without avjiil, or it« influence may rapidly 
grow lesa nnd leBS. Freexinfit tho back with ether spray or with 
Amott'fl ice mixture is nisn very sucoosKfol. So also i* tho old- 
fMibioncd way of irouiuft the Imck with a common flat iron, as hot aa 
can he fnirly borne, passed OTor a piooo of brovro paper placed across 
the loins. The thermic hammer, too, often succeeds in subduiuf; 
Inmbngo. These mode* of treatment I have found not so sno't-Ksfnl 
ia the leas typical forms of lambt^rc : for iostnnctis if the paia em 
movoment is restricted to one Ride, or is felt only on twisting or tnm> 
ing the body, and not on bending to or fro. 

Ijiimbogo is not ancommonly nssociatod with sciatica or ^booting 
puna along somn branches of the lumbar iicrviis, sometimes the pain 
riiootiog aloi^ the skin in the front of tho body, and along tho Inm. 
barorsncml ploxun, which then nssumcs a nuuralgio oharnoter. ^Then 
these two pains aro associatod 1 find that it ia oaay to core the Ittro* 
bo^, bat that tho sciatica or other iieumlgic oomjtlicatifln, r«maiuing 
nnnliored, is far moro diSicntt to dispose of. Occasionally, after 
eurinR tbe back by ^■alronismor tboneedloH, theuL-nrolgio pains giro 
■way, to be repiooed by tho lumbago ; and when the lumbago is got rid 
of the neuralgic pofns reonr. Let me rapoat that thraw compound 
cases ore genomlly obstiaato, and the neuralgic factor most so. 
Acupuncture will prove nseloss when lumbago is aocompnnifld by 

igfa fever, or when it is tho dnt symptom of acute rhonmatiam. 

It is a good plan, when rid of the lumbago, to apply to tho book a 
1>eUadonnaor a lead, or a Burgundy-pitch plaster spread on leather, 
1>oth on aM:oant of the warmth and the support it alTcrdfL. The Bur. 
(^udy-pitcli plaster Bticks clos«rct, but is rory apt to irritate delicate 

ins, especially in wurai weaUier, and often indeed cannot tw home. 
Iven lead or belladonna plaster may irritate the akin, bringing out a 

pnlor or oosematoos empUon, dse in pari to the rotentioD of por- 
■pintiao,- which, docomposing, irritates tho sloD. By removing the 

e2 



100 



AOUPOXOTCBX. 



plaster eTory few days, vipin)^ it, and wsshin); the ekio, and ibtax 
rcnppljring ihe p1n»t«r, tht* imtatioD mtvf otlva be jirvrented, or ih» 
platter may be perforated aft«r the maimarof Aloocks porous plaetor. 

I haTB fotind ncnpanctaro far lest Eucocvfal in tbc tn.-atmcnt o( 
scbtioa ; in a few eaaes it acta no doubt aa speedily and as oom. 
pleuly as in IninlNigo, bnt tbis prompt action in nnfurtunately tba 
exception. Some bold tbat it is aeoeawy to ptaroe tlie nerre^ and 
tbv nncortoin raaulta of aoapunctiiro in sc-intica may posfibly be dna 
to tbe needle sometimes impaJinK tbo uon'e, bnt more frequently 
niMmg it. This treatment fjf^cmtly givM tnoic, tbongli nanallj 
very transient, rultef, lafitiiifr only from a few minntes to an honr or 
so. In caeee due to diseased spine or prvmnro on the nerrca from 
abdominal solid tamonis, absceew, or Ewcat aeon mil lation, aoa* 
panctnre is not appropriate. Tbo needle miut bo throat in deeptyi 
even to Ibe bone, in varions plaecs over the seat of pain in tlie 
coarse of the affected nerrc. Wbon only partially inoccasfnl, thia 
treatment reranvca the |iain alont; the coarse of the sciatic ner^-e^ 
bnt gonemlly leaves nnaffected ihc pain below the knnc. (inpeoiallj 
oulAido the ankle. Indeed, I may odd, that whilst all forma of 
•dntica are obetinate, those cases are most rebellions wboa tlia 
pain reaches below the knee, or when it ia restricted to the region 
above the aoiatio toberoaity. 

Ur Dnmontpallior finds that acnpnncture of a spot, not the pain> 
fnl port, but ibo corresponding njiot on tbo opposite side of the 
bo<ly, will relieve the pain of nenralgia, acnto articular rhenmaticm, 
plonrodynia, the relief being in aomo inirtancea permanont. This 
" eotreeponding spot " is sometimes lender ; acnpunctnre over or 
nvar tlie scat of jiain aUo ivlii'ves it. 

Acupunctnre, or incisions, into the dropsical tissnca of the feet 
and ankles, or tower part of the calf, is an old, but now too ranch 
ni^leoted mode of trealinff both eaidiao and nmat dropsy. Aon- 
pnnutara no doubt Mmctimes excites eiTtlurmatons inflammation, 
mSoUint to cnnse tJte drapeical, vitally depressed tiwucs to slongh 
eitensively and pro g resrively. In one instance I have seen the 
nvaolea not only laid bare, bnt dissected out, over the lower part 
of tlie calf lo the exicmt of eipibt nquan.' inches, yet in thts case, 
after the dropay had drained iiwny, tho ticsaes recovering thinr 
lost vilolily, lu«lnl, and the man left the lioKpital grcntly im- 
pnivnd. It is Iwtler (o make incisions instead of prioka with lite 
noupsnctBre needle. Tbo incisiona should be from tlireo-qnarlers 
to an inch long, and slionld rracli well into the subontaneoua timine, 
or ihrea or fonr punctures bImuM be made aronod Moh anklo n ilh 
Ibe ordinary exploring trocar, thrust up tlie log in the subontane- 
ou lismoa lor an incb or an inch snd a half. Tbo higa abunld be 



iCDFPNCTCKB. 



XOl 



llcopt ilopciultnit nnd be enveloped in hot fomeDtnl^on*. The fottt 

I.Biiil ftiikles should also bo placed in hot wiit«r for an hour niifht 

Iftnd morning, to aid thti eioapc of mmm, As hot fomentationa 

^■onwlimea briofr "it a iroubleaome emp of ccsema, it is well to 

keep over tho indnon a motut Kponge wninj^ ont in hot wntvr, to 

•oak up ihedist-'hargo; but unless this la vary frequently changed, 

the dropsiciU fluid will rarcharffC and ran through tho sponge ; 

therefore, the bed should be protoctod by a larf^ piece of niacin* 

toah. If hot fomODlatJouN are uaed, th<,-r shoald be miute with 

» sotataon of borocic aoid, which tends to keep the discbat^ 

BWMti and IK IcM liable to bn'nfr out pntohm of eTytlierua or » 

nop of ecienuL Ur. Soutbey's now ircll-known plan is biglily 

usefnl in many caned. 

A« the dischnrg« qnickljr docompoEOE, and becomes oBciisiro, 
the clothcH and rt]iongt)!i used sbnold lio wtuilied in a solution of 
ohlorinitled eoda, or moistened with a weak solution of carbolic 
acid. ThfiM free inoiaions allow the etuiy eitoapi; of the dropiiioal 
flnid, to the relief of tho dixtondod and dapKuod tiasnes in the 
Doighbonrhood of the inuiaioiia, thuN laMCuiog the likelihood of 
inflammation and tOoughing, which are very apt to oooar after 
iDcnt pricka. One incision over eaob outer malloolua is genorally 
BttlBcieBt. 

Willi incUion^ tbougb, there is not much fear of slongbtngi 
Itill, nn this nntoward crcnt niajr occur, it is bcllor not to inoiaa, 
Jly witli verj' old or very weak paticntK, till otlier molhods 
Hbare be«D tiied tuid have failed. The bonetita are prompt and 
striking. Sernm rtuis freely from tho wounds, mi thai in a few 
koura piata may bo diitcharged. Ah lIiu fluid runs away, of conrao 
tho dropMy grown Iom, tirxt in tho upper parta of the body, of 
the pleam, and tbo abdomen ; hence tbu dyspnoon, due to hydro. 
thomx, diaappoars, and tlie tightoeaa over the upper part of tliu 
abdomen erases. At liutt the flnid drains ont of tho legs, and all 
tho dropKy is removed, and without producin;* deprL-«!ui>n, for tlio 
dnpaical flnid from tho cellular tiMtius nnliko inflammatory ex- 
vdationa, contains very little albumen ; so little that it only becomes 
opalescent on boiling, and on ailding nitric iu:id. 

If ibo aubcntoneona tissue is hard and brawny, and will pit only 
im[>orfe<;t]y, then nuither inoiaionit nor SnutLcy'R tubes will drain off 
any fluid. An incision, or ono of Soutbej'H tubus, otion Kctt np 
tfTttalions in tho neighbourhood; ho that a frosh incision, or the 
introdiiction of a fieslt lube, drawn olT no somm, but the tfocar 
beootnea blocked np with a pinkish jclly.like auhstancev snggmtiag 
the idoA that the jircviouii opcmtioua have excitod infliijuinalion which 
_haa filled the intercellalar spaces with thia jelly<hko anbstanco. 




102 



lOUPOXCTUiu: 



In cardiac dropsy it appown to ma that this treatment ia mom 
baDoficuU wImd due to aortic than to trieuiipiil miaohief. In dropay 
due to ftortio ragarf^taiit disoosa thera is a fiT»t«r tatdvncjr to 
•ffiMtoB into tho plenral and abdominal cnvitica than when doe to 
trionapid dtseaae, and the dropsy increases ntoro rnpidlr. Thns when 
dnp^ invadM tho f«ot, it unutdlj upruud* ({uiokly U]> the k-gn, and, 
betoro the legs am extensive!}' svrolltm hydrothorax often soto in, 
ombamMmg tbo already di«U«M«d bieatbiiiR; »o that in heart 
diseaae, and egpeciaily in tho aortic rognr^ptont form, in addition to 
tbo paroxyaraal panting dy«piia>a due to the heart miscbit^f, wo Iiavtt 
tbo oosutant djspooA or orthopncea of hydntbornx ; the orthopiMSA 
grviitlj prvdomioating oror the dyBpnon diroctly dependent on the 
henn. The incisioua into the leg draio oS tbo fluid from tlie nppov 
part* of tho hotly, lirst rmptyinR therefore the pleural cavities, and 
promptly removinif the groatrr ]>nrt of tlio dyiipiiuia. TbtK tmtment 
is aleo a»ofal in tlio dropey of Bi-ight'« disoasc. 

Hoir loDg will it be before tbe flnid re-nocnninlatea and the ad- 
TBBtago tbna gained is lost ? Tn tricuspid dro)iHy, ao long as the 
Talvnlar incowpelenvy ooutinuL'H, the dropiiy n-ill return, and the 
rapidity of its rccnnvncc will of course depend on tho degra of 
Kfptgilatiun. In aortic dropky, and tlte dropsy from Ilrigtit'ii dieeaae, 
gnocMi iB often much greater. Id aome eoMa, indeed, one operatJoD 
oAen disupatm tlie flnid, ncrer to n'-^m-nranlab) ; tlumgb more oft«n 
(wo or even more oporatiuuH at varjiug intervalf ore necoawiry, tbo 
Unid Mkcli limo rettiming less and l«w rapidly. In cnses of very ex- 
teneiTe dropsy, ttrange to say, 1 have known the Quid not to return, 
allliODgh tbe disease of tbe Iieai't or kidneys has remained unaffected. 
Thus, tbe araognl of albnmen, and the qnanlity of nrino, boo reouuned 
jnat the aanie in cawa of Bright'a disMwe.and yet after draining away 
tba flnid it has nervr retamed. I bare locn tliia vxctUent result in a 
case where the tisaooR wore shiny with diatonsioiii tbe abdomen 
targely distended wilJi fiuid, and tbe albumen on boiling oovupying 
half the tcaUtube, yet, alter draining away the dropsy by iiioiaiou, 
tbo fluid naTor re-accomuUlt-d, though the proportion of albnmea 
eoBlinued the tame. This {wtient remained free from dropwy raon 
IhttB aix months after the operation. 



COONTEK-IltIt ITATIOM. 



103 



I 
I 



"COUKTRR-mRITATION" OR THE INPLtrENCE OP 
KXTKRNAL AGENTS ON PISKASH. 

T local a |i{ili cations are capablu of controlling (Iikciwo I bcliovs 
pmotica] nic'D will bo inclined to deny, thongb trom time to time 
on thit point §om« scepticism finds BXprMsion. 

Tlifi influence of locul itp)ilii»liona w traDMmitlcd in throe diSorent 
ir»y8, 

1. By more contnct. 

2. The active prinoiple of the topical agent may pom deeply into 
tbo tiesocs and affect the doop parts. 

3. The iufiiieiice may travel ilirougli tlio nerrona system along 
afferent nerviis tii thu nerve eimtrci, and be Ihenoo refiocted to dtitant 
parta. 

Tlu! iiprGud of dimquto liy mero cnntnct is eTidonco<l in llmt form 
d ulcerative stomatitis affecting thu v(]gvK of the gnma, when tie 
oheok and tongtut nppotmd to tli<; inflamed and ulcomtcd earfaoo 
beoonie inSamed and ulcerated ; and luutilar extcusion of iuflam- 
loation and alcemtion tiy mure eontnd is witaossod in tho spread of 
noa^peoiBc, aa well as specilic, sorea from the glans to the prepuce, 
or vice mrtd; and likcn-i«i> whrn wo find a group of tubercles on 
tbfl pulmonary- pleura, fortued alHO on tlio opposite costal pleura, 
tlie morbid process having exteuded from one sur&oe to tlig other, 
vitfaont thu intervention of adhcaiuna between the piJ m o i ia r y aud 
parietal membranes. 

He eeeond means of extension by the pauago of the ootivo prin- 
ciple of the local application to deep parts is probably some limes 
OUimptifivd in thu cose of blisterH, &o., for Dr. Inmon and othuni have 
shown that btiaterv, and other counter-irritants, applied to the chc«b 
or abdomen, will in «amo instancos cxcito inSammntion of tlie corre- 
Bpondinjit port of the pleuiaor peritonenra; ogsjn, au ii-rltant, applied 
to a Ichm distended by Bynovilis or rheumatism, inoreases the distension 
for a 4lay or two. 

Uy the third mnona pointed oat we affect dii^nt parta not toxtur- 
ally o<mnuotud wilh tho ttaanes to which the topic&l agent is applied, 
axcept through tho nervous or voacolar ayxtem. In this way we can 
inflnonco distant parts both in health aud iu diseaao. If in a state of 
health, as Drown-S^uard points out, wo irritate the skin over the 
kidoeys, the renal artoriea will contract ; and eold applied to p&rt of 
a list's wing will caose contraction of tho venteU of the oorro- 
apoading port of tho opposite wing. IiTit&ats liko suoff appliud to 



101 



GOCyrZB-IBAlTATIOS. , 



tbe nose, flxcite sneecinfr, audipocaciuuihaby iUcffoctODthstamtno- 
tiomi i>E theacrvoH of tlic Ktomocb Gxoit«s nausea, a cotaplex mcU 
involrin^ not onlj' an elaboralo co-orditiatod tnniictilar iDovomoDt, 
bat also mcroucd »ocivtinn of thu tuilivnry glnndx nnd of thv mnoou 
membnuie of tbu brunchial tnbes. There are inanf otbnrwoll-knoirD 
phjsiolofpcal inBtiiiicra of the prodaction of diitant effects bj meuu 
of ft topicftl appti««ticn. 

The romote effect of a topical agvnt a mndt muiifeat in duteue is 
A IwofoM manner;— (I), by the irritation prodnoed by a given 
pathological condition ; (2), by a raodtcinal application. The cETcct of 
a pathological topical irritant i» ahown in thv followinj; examples : — 

Tba iiiOu«n«t nf • ImaI irrilaUni la Ih* produolioa of aonnlRu lalni at k duluo* 
fcem til* tttrling foiat l» well (xcmplifieil JD neafilfU of iba »rUiiu bnnahw e( Um 
dftb IWTT« from * dbsuod toolb. Cuu mtt on rtootd vberc irrituliaa of «M lurtg bM 
excited noimJgw io tnathfr nerre mnatominllj unrel&tei) to il ; for iaelaora, lajorj 10 
lb* oloat norra hu tudlucixl iiMiiftl|[ts «f tbo fitUi. Varioiu Miiou* nnlrlllro cIiukm 
tTii; lako ptaoc oror the Monii'lAir ■"< t^ I**'") >l>* itnjJIeaUtl tlaaDsi b««tiiiiiig red, 
*«oII«n, rsrj leuder, aod erca iadiml«<l, tai o«iml(U «l llio temptg «tun tnru 
Ibe h>ir of that part ntpillj gnr> "hilit Dennilpa in tbo aj* badi to bmIom Indaa- 
Uition, •aindime* orta Io oleontlon uf that uri;KD. KnMtioD, Un>, nay become modi- 
Bfl ; U>iu caeb puoijna of paia ma; inmaM, diniLuiib, or alter llio aaUvat; «( 
la«bi7aial aMroligb). 

The eScct* of a medicinal application in diJicoito !a woll exemplified 
in the following inatonces : — 

Tbe api'licallon ol aconltla oistmant orer a palaful oonnlgle airro ofton rolitTM 
iiiUDt Dtutalfiia, &ad •souliaMa (iokocH. {Sot Amuiw.) far Inatanto, «e otiea tai 
■ Mn of Btar«l(u ot lli* opbtbaluie bnoeb of Ibc Itttb ourn tntlovol in tone bonra 
by aeutalsla a( iIm auricular or oeelpititl o«no. Ilaro Iba ulotnient. by r*lirriiij[ iW 
Hixa-orbilal pain, ■ill prenot tbe ocuimlgLi o( tbo other norro*. Aitia, in Mnnl^ 
■IdL bettdacbf. thit ointoiMit. b; alaluhing tbo npn-orbital i»!n, whicb cfiea rardiaUa 
tar atvn IW brow, vtll prennt Iba Moaaqooat ai^noM. 

The inRttcDce ot a topical ivmody tra^'eIIing tbrongb the nervons 
By«t«iD will affect distant <ti»eftM*) portA in too ways : — 1. Il may sot 
liirongb a healthy ncrvons NVhtotn ; 2. It uuiy modify or ranore 
diseaae of tli« ctmlnd aervons syslvra, and so reaiore or Iwirili the 
effects of that diwaae nuuiifonted on a distant part 

I bare alntady exemplified the fint means of raaching lli ■MM 
throDfh the healthy nervona eystem, aiid will atttmipt Io bhow that 
it it probable or at least feasiUe, to lufor tbnt in rnriotu vrayN wo cmii 
minlify nutriiiuu, acerotion, Ac, according to the nature of tbe 
ni'plication, and that we tony hope in time to apply our local ramediea 
with far (pxtttiTr precision limn hervtofon?. ao as Io iooreaM^ ehvok, 
or ativr nutrition or sncrelion and to ooutrol diaoOMid cbuifea. 

I will lint oooiidor the inflneaoe of toplool appUoatioM on distant 



.OOimSB-IRBITATlOK. 



105 



porU throoglt tho heotUij nervous ftjrslciii, sterting with tUo genernt 
prapocitioa — tbat by means of local agents we caa indtioe in the 
central nerrocit ftytUtm a meuuuroloas mriaty of cbangce. First, I 
dr»w attention to tlio fact tliat eeoaory norvca can convey u grmt 
TBricty of impronaionit, aiul ninut prorinco a corresponding variety 
of imprwsionfi on their nervouti oonln-s. Tropliic neircn, or if 
[ there be no tropbio nerroe, tlicn somo otbor nerves ministoring to 
nntrition nod socrelion modify tlieae ]>rooeit)ie)( in miinifoltl ways, 
and !K) uuKt be capable of tnuismitting varions iDiproesionE. Tbeso 
varied inflnencoa on nntritiou depend, of course, on the oundilion of 
the narrous centres; and if wo aro able variously) and in different 
dogrms, to inflnence these nerronB centres, we may fairly expect, ia 
many modes and in different proportions, to modify nutrition and 
eei-retioD in distant parts supplied by the trophic- nerree. 

The ncrvoB of sonso will amply illaisti-nto tho nnmbcrlc«a indo- 
ut imprcuLons tranatmibsible by tbo nerves. 



hThc t 
Bnflti t 



Smrit. The odour of two Uodi of Bovei* is nertr aliko, sad wo mo deUct out 
UmI ot ilovor troin uoUiei bj iu it»iit. 

{(.) Sigil. Tbs gnat yuittj o( (linJn ol solour Id utnni erMr; tpcdts of v'^^'j 
tot iiMuio*, btTuij it« ilialinFtin ihwlc. 

(c) Htariuf. Ng tiro vokaanklika; iDortorw. in noaodKiireoaD delMt gra^luAU;, 
Ml infinito rncittj of lim&ri, or <ju&li(f of wund, t* ftpul tnm iaUult; uid [dleh. 

(rf.) Tatif. We nui diicrlioiiute (aTOora in >a ondlta Tvitt^. 

it.) Tauek, Wo know moBt obJMU b^ tactile ptrooptioit Tbe mme nem etn conrt; 
ininite Tsrielle* of |<kia; indiod. it » pratahls that m idgnliokl |Hila doca not oocar 
lwi£o fvt in twa teiiiUKW illoeHti, oii id ditTcTtul lodlTiilDiJii. 

If tbo dottiiito of "ipwalic cnoipts " oi "i[icci6o [uaotion" of oerres tliooU tuia 
oat to b* MRoeW It moat ba kdmiitsd ttuil macb at Ibo ariiumimi in tbU ttciita will 
low il* Ion*. 

A««ei4iag to tUi doouiae, the dlffonnoo belir««n oorrc* depsods on tb> diiTenTili 
COMtllnlloo of tbiir csd'Or^uim, or thoir peiipbcnl wvd wnird ttrmlnsliaoi. To tsko 
tbo CSM of tbo t]r« :— Tbo jviiihtinl cnd-eisui o( «vh bin cu rccIto an impttmiim 
hom ona otloiir oalj, otber toloon being inmiialilti of Melting %o imprcuiDn on tbst 
Dcm totmliMtlon ; a norre termiDstion «ba»o tunalioii It li to bo ciciiid b; jtllow, 
baing BSriMpUTo of u impiiHloa of blue, Iu. HcDce, ccmpoan J oclosn aro split Dp 
lau dnplir oolonn, and to oondnMod to tbo •anioriiiu. Tli* onio I* lopiiOMd to bs (bo 
MM «hh Mond, oonijilM Mund boinf deoompond into iU oomitaiwaU. In tho orKumtnt 
In tbU itOioa I boTo oooglil la ibow ibu osoh norro out rccvTo uid irnnirnlt to tbo 
brain * cmt ntioly ot bopnadon*, and tbit tbo tiopbio ond MCittoi; norvca In thait 
turn cbb ■!«> nuh rurj t. grvtK vaaj inpraoion*, snd sol mtntj loeraiM or deeroMO 
the acliiil; of KcrcllDn or nDUllIon (oifdilion of tiunc). but Ilkoow, witMn orrlnin 
liuiilo, uioilit) Ibe nature of tbo componudi formoJ in th«« \wa proc tm s. 

8appa«in« that a nerra-«nil tan nuire, ajid Iborofur* iU IcQDk oin uodaot. onljr ono 
kind ol inpiMolon, It la liard to oapkSo bow *a ein d«lc«t limbrt, or quality ot aoaad. 
W» dbtiogaiili oao lutramtnc from uotbcr, naj, ono Tiolio from anotbor, hj ibo 
qoslitr <J ita lounil. AKain. bow can vo eipUiu Uio grtni laritilen ot pain I U MOh 
diilinttiTit lain oDn<tuiud by a atparal* nem, and do tbtto coftdDOting n(T*M difllv 
I ouvlBcUng jibjaiologicBi owtiono I 



yfo Me, Uierafore, that within ita natural sphero ekob nerrc con 
fionvvf KB ftlmoat ondl«M rami;' nf iinpulMW, wliioU must induva a 
ODrrmponding v&ri«tj of cUangoa affecting; the t«nuiiiations ol tlw 
Borvos, tliii ncrvuM tbenuelvca ; litcir nncloi itnd tliD eonw>ri<im ; in 
otlier words, every kind of soneation eicitfis a diiferoDt tnolooalar 
■mnfrcmcnt in the n«r\-cM and tltuir nucld. Applications to the 
ekin of riiustard, couthnridM, aconite, veralria, Ao., mcli prodaooH a 
dialinut chamclttrutio •euaatiun, nuili dotonniiMN b distinct molocalar 
amagemcDt in Uie aeivoa and their naolet. 

I mty bar* b* •lloirvl U add, Uut to nis It Haint InunevlTibl* tbal * cDmal atDtd 
nemni. vbttbcr ctcctrk « •lljci) thetilo, un prqdoM tha niea«anla« imrlaljr o( 
MuatiaB* «a oaaitulljr tiporiUMi (or a ndctj iu Iha )|iiuilitj aoil utUnailjr ol tbs 
comnt voabl tiuplf intaaiUy the laaiMioii !a ■ eorr«*iwodia) dccn*. A cr«at Taridy 
•f NDMtioiu mat(> thgrafora, b« doe U a nrjing (uoImiiIu anaogsiDCiil Id U« Mrvw 
and Ibdr diuIcL Bat if impnamoai an conrc.tod thraocb ntrrn bj cnircnt*, tt w 
niKltvao tadlMa taricrlrid tliaMcnnwiti^wblchlDdaw or d«[icDd on diComt [dijnital 
tlalaa a( iha narva. 

Kntrition and socretion tlicu, om wd 1ibt« nen, may bo varioady 
modifiod bjr tho state of Uio oonlral oerrotis B}-st«ia. Tfana iwaimlgiB 
of tlio fifth majr muBKi inllninmiitian or tbickvniug of tbo ekin ; or 
llio kiiir to ifTOw thiukaud brittle, or to turn gnj; or it may caoM 
nlcomlMtn of tlio oornw, or muting of thu retina ; or induce thicken* 
'tag of the fibrouB timraoH ; or check, ur uontivl, or probably altur, th« 
bcUrj-niul antl salirarjr uecretion. In tbo omu of tho italivary Mcrction, 
pntienta wniotimcc nj- that tlic tasi« of the apittlo ta different from 
titat of health, allowing that it« iiualilj^ tit changed. We haw aeon 
tliat ill rariotti waya neuralgias ma; modify nutrition and aacrvtioii. 
Thaae modifications muat de[)eud on difforent impulacs coavoyed bj 
tlw nerveatanil llioau, in their tuni. on n diflcrcnt inoLocular condition 
of tlio nuolena, or part of the nnclenii. 

If, in diaoow, rariouH nnnoto affocta on tho natritive and eocra. 
tive procenMM take place, according to the ooourrenoe ol xariona 
ohaagea to the cvnlral nervoaa s/alem, it Mwnu rwMMiAbht lo 
}iramii)a that wo may likewiM, in many different waye, amiod 
Witb the powiir to influence difltant nalrition and Morvtion, fairljr 
hope in time to be able to ohooas with precbioo a local appUoation 
adapt«d to the natntv of tlio dlatant change wo doairo (o effeot, 
inatAiul of, lu now, preacribing in a more or Icn hapliawud hahioiL 

Ifvxt, I alialt (ionaidor the injluanoe of local a|>|ilicntioaa ou the 
tmttnl diaaaso of tho nnrrova ayatom, and the modifyiuf; and con- 
bvlUng offeda of tlieao agtmta on diaeaM at a diatant part. 

Varioua diaeaaea of lliv e«nlnd DerrouB aystem manifnat diatnnt 
morbid offeeta. Tlins, in nvaralgia, aa of the fiftli, wo have pain 
nCamd to tliat osrvo, witlt natritive ohaogM ia the UrriloriM 



C01:XTER>1BSII&II0\. 



107 



I 



■■{iqpKMI by it. In negraioe ne iiavo pftin referred to tli« fiftli 
with nAuiM, nokim^ pcrliape slight jnnndico or diaiThoeo, or con- 
Etipodan : in asthma we Itave wvero dyspiusa ; to int«miittcnt 
bnf •Mtthma, u it hu been called, w havu enorgcbic and repon(«-d 
altacka of BneoEtD^i and in epilepsy, violent coDVulnru movi-nM-'Uta 
of the n-holc or part of the bodjr. Thuno discssCB, in mAn; in- 
staoces, we are aibit more or leaa to control by local applicutiona, 
vhioh, bj tltoir imprcseione tr&TcUing ulong the nerves, urcet or 
modify the diAWMsd cwntixl changea, and so modify or arort the 
nj^iaptoms. 

The effect of local imprcMions on the ceutjul diwnso 1 vill con- 
sider under two heftds : — 

1. The iDfloenoo of distant morbid irritatioa oa the central 
diaeMC- 

2. The inRoence of local applicatiODH. 

Under these tiro head^ I will Hpcak of uonnl^a, ostlima, mc- 
graine, and vpihipvy. 

With regard to nenralgia, n few preliminary romarlcs s^m 
oeedfnl. By * tolcnce, the application of irritant^ &e., in the 
terminations of a uervc, vre of oounw excite pnin, ar\(\ the mnso* 
(|uent pbenomonA follow in this order ; tliv irritunl, by producing,' 
certain molecular chan^crt in the tcTminatioiis of tJio Dcnoe in- 
daoM ehnilarcluuigcs in the nerve trunk and in itit naolciis, chnngcn 
which tlience extend to the Mnnoriiim, and on rcmoring iho canso 
of pain, tlie molocnlar arrangement reverts to itn original condition 
and the pain anbsitlc«. In every inntancc of pain, however pro- 
duced, muiecniar changes may involve tbo uacl«i of nctvcs, or lliii 
ewtripctal fibres puiising from them to the semnnnm, and these 
iBoleciLlar changes most bo similar to thoso occmring in a Domutl 
aoD-pisiafnl eenaaUou. 



TbcM pslofal malMoIar elitnctt of Uw nnolciu id*; b« iitidiiacd bj (I) affHllon a( 
the Mrro in «M)u«tion «tlli do dooImu ; (3) b; tllieiM lnra)iiD)i, list not inttnyiog, 
lb*liMku*; (S) bj imprsnioni ooQTcjtd l)j& nene aDntaaiiiMd *i(h tb* aaalvDi^ 
rtleb letpttwioni t|irMd bcjonil iu ova ouolmu ; orlnTui^ iUcnrn nuoteua iioaflMlcd, 
Hv^M* cbtnsM in a put wbisb i> not dincll; coDDootcd ; (1) b; mirbld niftiun in 

ItoUMd. 



Pain depends on a molecnlar change ditFonnt from that of health 
bat of the same naton. Thus, for the prodootion of paiu from any 
oansDi the oompi«)tion of the nnolotis mnet remain nndextroyed ; 
(or, woTD it« composition alborod, wo should fail to got thcso mole> 
oular combinntiniu noooswry to excite any sonsution, whether 
natural or painful. The nerves, it is evident, cannot oxcito mol«- 
oular changes in the unclous if it ix replaced by a morl>id growth 



108 



ODUSTEB-IBBITATIOX. 



of niif Icintl. Oiic osooptwn there is, liowercr, to tbe foraging 
Bhitoment ; thiu a now structure like libroas tissuefi, tabnole, or 
cancer, replootng tli<i nacleus, ttmy uut im an irritant to the cao- 
iripotal fibres goinK ^ the Bcoaoriuni, eiffectiiii* in it moleoultu* 
cluTij^iM proiliiuing n KcnuAtiun of piiin. With thiM esoeption, ko 
Btight mnat Ixi tUe altoralion of tbe Ducleus in nenr&lgia, tJiat, witli 
our pniMnt mtcroaoopea, or obemioftl teflta, vre con hnnlljr hope to 
detect it 

MM iiatliaritia^ I knov, bold Uiit tbo condltlDn nf ths nsma uiU of thiir CMIrM li 
lh« auna with % laintnl m a uoimal waaaiion, pun, iad«iNl. htang "• gradual uktmm 
of tho foolinic tliM MoampMioo otrrjr wnwrj ptocai," aBil " trvrj wctmh* ot otdiou; 
Mnior; Hlmull U uptble of pTOilucliiG pain u iixm w it nlUiii* • ocrUln latoluilf." 
Pain, in hut, ti aUlcd l« be mi cxoorire normkl (DnsiltDn, oot ililTgroDt ia ItiuJ but 
only ia dffrM trom U» molooolar Madiiiona ol iha Dorrn und iu wntn from Uiow 
•CEWltog in * tHtan! KBnuUon. H«no* |Atn matt alwojs t* itranpr Ibui the 
BUlnaB ntrnul Moutioni ol Ibe nern. No^ I nniai* M *ii(gMt wmo flaouJontiont 
in fafonr ol the view, tb»t Ili« «ontlilian of ths norni and iU osntrv Ii dillortat fa kind 
U) tinir rondititn Juring i nataril ««nuitlon. 

It niiut be admitl«d thai a norra and lu ocnire «aa KBamt molMntar arnuis«ni«nta 
diSoriQt ftmn tbi>«e abiob Dccnc duiiiiK a nntural tniMtian. Tho pbTNckl oanditlon «( 

* D0TT4 and It* nantlcnt contra mutit bo dilleroat in itchine or furmicallan innt that 
Modilion durii^ a naturjkl HuitiOD. llihini; or tonnloatioD u geaenKj a ioaalMn 
far (00 foobia la b* aeooontod an o»<(an()oD of a natural Hntaljon. Tbo ooodltion ol 
norro and cantn niut dUTor altofttfaor (ram tho Mnditlan of a natural KOuaUoD. 

We ma} h*<r« paiafnl fonnioallon and laiofal it4^bi^t, but tho Mtaationa arc itUI of 
the lamo tbanclar a* tannlckUon or iteblnj of a «Mk kind. Wo out omU; doiott thai 
•ilhv diflbra only !■ dacrotk 1 an tnolinod to maialain that thU b ahM tba mh wiih 
pats vUah nuv bo to ali|bt that it oan aoatotlj hr MX, thongh a* dintiDMire ia 
obanclot (hat «* correctt; call It jaln of tbo aama kind ai a tboraoKbl; palafol aaa- 
aatloa, Thu*, la appeal to mj pemnal eipcrieo^ I am Mrlain (hit In (ka aam* 
aarT<. ai, for lutanw. the ao|ira-orbital bianoh of tho fifth an'l ths uiatio. witkln • 
fa* uinntoa I ban Mt Ba*ara |ula, and aooo aftrr an 'IkUx tLinibir acautiMi, bat a* 
alight a» to b* acanalj notleaaUc I ballon tbat pain, l>fca llohln| or faraleaUoi), aaf 
ba at an]t dtgtM of iDlonstf ; ao veakaaaeaTwIjio bo pertvpiible, or ■• ttnot oa vi l« 
anoodsiablr. It can batdlj b« mainulnfil tbatthii iliKbtaal fonu at piin anoitlMfvo 
bslurai aoniaUsaa. tar on (bb fipaalljon no (uia thould or«r *iiM wbloh b Ml «■ 
•xnaa ot a oatnral atnatioa. 

[ now ii(«otnl a tao* vbbh to mo ofoai* lalarpratablD bait on tha tuppoaltioa Ikal tbo 
oondilion of tho nanaa tmi iboir santra* b diflonat in pain from tboir eeodllioa datlne 

• nortu) aooMUon. 

A fondemaii aoAiad fnm a atTara atlxk of borpca on tbo btl aiila of bb PMk, 
faaek ol ht>d, npptr part of ehaat and book, the wnption eomloi; out la nopa, each erai> 
balsg preotdrd bj rttj tmn noarBlflo palna. On raeoToiiaG (ram tbe baopw bo •«« 
aoiaod with altatka «l a^niaioc itobing, iMling aboat a iDarier ot an banr, Jul vnr 
tba Mundgio tnM. Tba apidloabon of a varj hot apoago vonbl alvaya albf Ibo 
llrtu^ bu till lk« pamifam paaavl away It vanld ihifl la analbar ootro, and lial^ 
drlraa (ran Ub It ■ooM tt m a third, and w for^li. With Ibo allaaka *l ilafciig 
ho had ooaHtoul h<U oot at all mtoco aboollag pala* in tbo rogiou a&cui witfc tb« 
Iteming. 

Ro> (I Mtr be tM that daring tb« unnlgb Ui« Mtn^ n mm prabab!; tMr 



CODXTBR-I RarTATIOS. 



109 



I 
I 



««oti««. wm in an fxoitab1« coai^ition, to tbst s nomml s«dnilioB wm («lt u |i£&. 
HuI thin in[|Tr|>rTt(iliun ■111 not tipUin ihn tiirriblo Itnblng ; btro tlura mnit bftve beta 
a <liflcrFBt iDolcirnUr uiruiEcmcnt in tlin dcttc eentm. I Bubuiit tbflt tb« Qriileno* 
Undi lo ibow tiitt (lin |iiiin «u iil»(i <lu«. not to «■ finilHliln wmlition, t^ul totn tlt«i«d 
molMaUr imiigemiuii. inid ibil tbn mali-cDUr arruigemsat Kgiio nndenrent a obango 
cOMOfDitMillj ■itb tbs oomt ot tbo iialnfal itctiiiii- 

1 BMj nttt la Vt. Aiut<«'> wtll'luinirii >ri[uiucn( in (arogr of Ibo t!«w Ju<t adrtaevij. 
I( pain II iliip to ui oultablo eondltloli ot Ibo dcitc or tti ccntrn, Dilnnl HniillDn 
■boulJ 1m hoighleafd orcr a n^nn)){i<i ttul, irboroiui lb<> n|ipaiiM condilion ii o(lsn 
alstrtrd, Ibg nonnnl mivaUoo ia tba ii«unlgle lanluaj being id niDy cum Eroatlj 
t)lnnt«d. 

Tf then, bnting tiie forttgoing exception, dinago !n thg naoleoa 
mniit ocvnr it) every case of pain, how does oae painful dieniiw 
differ from another ? Thoro um diiforuncuM which a mere alt«l^ 
tion of tliu molecular arr&ngement cannot explain, fur in painfal 
diseases, if there i» mwflj- a differttot urriintj^iMacnt of the molecnles, 
]Hun would diffur only in character and intcn&ilj-, one boing shoot- 
ing, another throbbing, anotbor baring, bcsideB other dlfferenoee 
not to be acoount«d for by mere dlfferencoa of molecular diangoii, 
travolliug by niTcrent nerves, involring their centres. Noutalgia 
in many ways differs from other pains ; — for instance, an irritation 
aSocta not only the parta of tJic nncli^os connected willi the nervu 
along which the effect of irritation tntvels, but the effect diffuses 
itni'lf over otliiT partii involving more or Icwn every part of tlio gan- 
glion, and even tx-yond it ; thus, a airiaus toolL tmnsmits its paiD 
along its sentient norvo to tho nucleus, and the impreesioa diffcKOS 
iUclf through the whole or pert of the naolens of the 6fth norve. 
This is the cnne, too, with other Renos. Nay, tlie infloenoo extends 
l)cyond I ho nucleus involving other nervous centiv* producing vaso- 
motor changes, and, if there are separate trophic nerves, their oentrea 
also. It may, indeed, reach motor centres and prodnco spaonodic 
vontnvction of the facial mnscles as an epileptiform tic. In tran 
matic and ittrychnia tetanus we hare a good iniitAucc of tho diffu- 
sion of the impresaioD beyond its own territory ; in this di^aiuto 
a ohaoge ooours in tlie cord, which enables an impre«inoo on a 
nerva to diffoso itsolf throughout tho cord, producing general totanio 
contraotions. 

It luay bo urged that tho extent over which the improMiion diffuses 
it«clf is attributable to Its violence, but in other forma of pain, even 
tlie most severe, duo to violent cansos, wo find that as a rule the 
effoets do cot cpread, but the pain ia limited to the injured part; tlie 
nulocular changes induoed by tho irritation b(;ing Iimit«d to tJiat 
portion of the nnolens in nervous coimauuioation with tlio irritated 
and painful paji< Partial cxoeptionit there arc, no douht, to this 
statement, for pcnons endowed with what is termed a (enaiUre 



110 



COOSTBB-IKKITITIOX. 



Berron* ijftem do nndoabwdlj feel pftin orcr nn nrca mncli widor 
than the part hurt. Noarelgift ia veir apt to ooour in Uicm omtitUtn- 
tions- Thftt tbo dilTtisioii of th« pain in n^tiTxI^a lo nDin-itatwl 
nigiOBa ia not duo to tbe Tiolenoo of tho irntation i* rAiivluHJTolj 
Klkown in miiDf ouio« of kcvcto nonrnlgia of tlio Bftli, wh«ro Ibo 
slt)f1it«st touch of ono point, even of % hair, will induce s severe 
paroxysTQ, involving mnny bntnchrx of tho norve. Nor in the iliffg. 
sion of the pain duo to tlie eiattod condition of tho irritated norvu, » 
that a slight irritation niay cauNi- it to tmnKiait ii v«rj powerful tm- 
preaaioii; a fa«t clonrljr Bhown in a case recorded b^ Dr. Anatie. 
wlieitt injnrj- of ilio left j^at occipital oervu causod aouivlgia in tho 
Bfth, an<l where the slighicft pressure over the damaged ner\-e inducod 
TFiy severe pain in the forehead and faec, altbongli the ptun at tjie 
point irritated traa not groat«r than would have ocoDiT«d in hra)tl)t 
abowhig that tho imprcMiion oonvcvml along tho injured norve waa bjr 
no means great, or conaidemblo changea would bare been prodoood in 
ita own nncl«tut with corrcuponding pain, and jut the iinpreeaioB was 
luleqaatoto exciito aevero pain innianybrancheeof tbe titlh. Thin cane. 
too, proves coDcluairelj that the seat of neuralgia is not inherent 
Bol«If in tho norvea, hut dopends on the condition of the norvona 
centre, for, wore only the nerves at fault, tho neuralgic pain alioald 
he fult in the dutcaaod nerve itaelf — not in tho torritoiy anppliod hf 
another norrp. 'I'hig want of imtation of moteonlar cbai^ to ibo 
IMrtionof tbe nncleua in nervngs conneotaon with tho part produciag 
it — thta diffnaibility of molucntar chaugo— must be due to Mm* 
altared ixNadition of tbe nervoua centres. Thia defect is oommon Ui 
diaeaooa allied to neuralgia. 

ThuR, to HDin up, wn Iwre aecn that a diwased tooth, bonei or olbar 
irritant, incites molecular changm in the nucleus of th« affected norva^ 
producing the itenaatien of pain ; that, owing'to a defect, the naturo of 
which has hitherto rouainod andetacted, tbe influeoco cxtonda beyond 
the part of the nuclenn in connection with the affeot«d nerve, Ro that 
the tuolui^u la r alteration involroeagreatorpariofthe entire oucleoa, so 
that pain ia roferrw] to parta supplied hj nuaffeat«d norve*. Indeed, 
the infloence of the irritation may fxtond beyond tho nucleus <>f lite 
nf'rvrtonrighlKmring parte, and theee.excilingniolcQntarcbangMiiBBj 
prodttoe dintaut motor or vaao-motor and trophic ohangoa. Tbna, » 
Jiaised tootb, Ac., may canaomolecniar changes in tltv whole nuolou 
of the fifth, producing pain nrferred to every branch of that nerw, 
nay, the influence may extend and involve tim nucleus of the seventh 
nerve, inducing apnam of the facial mnaclea. Farther, it is mil 
known that varions nutritive changes may occur ai the acwt of the 
refemol ]»'m. showing that an influiiice is propagated, either alo(i|> 
tbo senaury or trophic Sbrea from tlieir nnolvos, to the penphoiy ; 



I 

i 

I 

i 



00 U NTF. R- IBBITATIOS. 



in 



^t tbns, ovoT tho seat of referred pain, v&rious changeB occnr ; the h&ir 

^P niAj turn graft or become coarao and briCtls ; the akin booome a3t«red 

or even inflamed) and nesnme an appearance mtioh like or3:BipcIn8 

(Aiuliu) ; or tho ^o naj bocomo iDiLnracd, or thu rdtna di«oiuK:d, ho 

B8 to damage tho Eight. 

Th» InlliHine* cJ tl)« ncri** U Htipawl to Im ■hmm In tho mm of bcrpei >n*Ur. 
Ilttc the pktrbis nre Mfttcd tJctg tho eoarwi of uu intermiul uirre, Ibv pitch:* antl 
Trtirlo* btviag STtD ibrit lone mraiarriDflnt in tlm <llre«tiaii of tliii n<ir<t. Tli« wuno 
iblng ti Mrnvtlmts olHtrrdl In othar rwhu like piatluli. Id thow fin lb* nu>h ll 
Uplntcd to he ptadaTCd hj Mrmc illenlipan in Ibo nrtre. I think uoUw Ti«w nikjr ha 
plftiulb'y nuntiiaeil, tli*t tba nenf iIkm not |>r»liic« ilia n»h, but onljiletvroilnH th« 
dimlion it (buiU «Muiu«. Thli Ij ccrUiul; tho (aw vith Hnto mbu, u, for liiKlnnoi, 
that el cbi'keii-poi. Ihoogh Iho r»b it, wilboDt doubt, ilna to > cpcoifio pouon, (till 
tho T«aloles tud pil«liH of ivdnctB atoiinil tlitn an iofliKiDcvd hy tho inltrrostal noma. 
Tbna on tho (a«N oxtr«nittl4i, bach and Iront at tho bodj En tho mUJlo linn, ihe 
v«nolN aO'l iha attnulut T«dM*a an launil, but on tha ridoa of tb« obcit Mill abdaaan 
botb tho rtueloa anil tha radoaM trt otAl, tho laa< axia ol (hs vuiolta and patobaa of 
radcaa nuulng in thi dlrMtlon of tho inltrouul mma, UoIiik <juitt atlinnire ihg diott 
abnau bnt obllqat at Ita lovot [uui. Tho; ars alio athvut tho toini. Tbo muid la 
M*n In llie Kan frntn amall'iiai. TbM« ar* oial, with ibfir looa aiii athwart iho 
ctaaat, ud obllqna In Iho diiEction of tho nartea on th« lowtr [lart ot Ihe chwt. and 
Mot tiM abdemen, whiltt thej ar« round orer tha ^nntv tho itomnm, anil on tha boa 
and «(tninlti«a> 

Ifav, in Ibaao inalasota, It «n hunll; bo claluod fot iho nervoa more than that ibof 
^^ dtlamliia the ahajNi and dirootioa of the Tciicloi, sod tho rwlut**. 

B It is a rather cnrionii oimiinittaiicc, that dtirini; the continuance of 

the tuianli^ia, whilst the originaj irritant in in oponition, varioim 

minor iitAtteace« will excitu poroxysniM of patti, In ncnralgia £rotn 

laitiNcwtod tooth, or diseased bone, &c., irrittttion of other branches of 

the Bfth -will proiUw) a paroxyjcm, oven a breath of cold air on tho 

face, or tbe touch of an object. In each cmo the pfirax.TMnal i>x- 

dtants are few in nnmbtTr, though cold air may bring on n poroxTsm, 

_ pcrhaixa pinching, er other irntatiou of bhu same spot, ia inopera- 

H^ve, On removing the prinuiiy enttso of the neuralgia, tho attack 

^■ooMce. and then irritation of other braaobe* also faila to induoo a 

^BparoxyHm. 

Wfl have jnst seen that, daring nn attack of nonralgia, ihe par- 
oxysms arc indnced, at lonst in many cahoii, by only a few irritants. 
Thus, in some cases, hot thiuf-M b tho moutL always excit« n jiar- 
^b>xysni, in others, only ooltl things ; n^iu. in Komo instances, a breath 
Hof cold air oo the face brings on a pivroxysm. whilst in ethers, cold 
Bmir ral><n-os, antl warmth excitee the pain, yet any other kind of irri- 
^■falioo to tbe Mune nerves produces a nataral sensation and no pain, 
^•nd is felt only over the scat o( a [i pi U- at ion. It thns appears that 
only certain, and often a very limited nnmberof improsuona, pecn- 
^Ju to o«cb case, can indBC« that tnoloutUor cbangp, which, dif- 



112 



COOXTBR-IRUITAIIOX. 



fnidng iUeU throngh the nucleus, trauHea the poroxjinn of |)«in. nrliilst 
other impnwsiona imlaco ntily natnnil molocnlnr clijaijfirfl, rxclliii]; 
nnrmal Hcnaationg, felt meralj* at the )Kimt of contjiot. Tliia f«ct ia 
iitrikingly itlitKtmtvtl hj the cliRorvncc between t&o effect of nconita^ 
and tlie iujiact of cold air. A bi«ath of cold air will mbc a meirere 
pftroxj-iim, felt tUroDglinnt the territory of tho nerve, whilst the 
moonitu n-ill «!xcit« tingliDj;. rf»lnoted to tlio arra of it« nppltoalion, 
not distributod throoghont the notiralgic tract; showing that the 
nucloua does not allow all molecnUr arruiiKi.>inmt« to Hprend through, 
out it, hot tlioiw only of u wrtain character, Tnrytng indifferent easra. 
It maf be said that tho impressions producing tho pnroxjrHin ant 
Btroogor than thoHc which induce only a local and natural senulion ; 
bat this cannot he so, for in a case of neuralgia, tlio Klighlcnl oxciting 
agtot DUijr bo BaCfioicmt to prodnco tho pain, whilai powerful irritatiim 
will noti as a rale, iuduee a paroxynn, but only chamcteriiitic senm- 
tton of ttio irritant at the point of ooutact, though, in some aevere 
cnat-H, alrocMt any irritant applied over tho temiinatlons of the nerw 
will excite tbo paroxysro. 

[» tJiOHo onaea, thotvforc, when only oortain kinds of irriUnta, 
like cold or heat, will induce the paroxysm, other application)! of 
irritant agents will excite aimply their own cWmcteristic aensation 
ttb the point of contact. It appears that one of two view* i« opw 
to us : — either from some alteration in the nerre, an impreesinn 
oupablo ordinarily of exciting a uatnral non-painful Muntion. 
Indncea tu ita ateod, morbid molecular changes, nnd thoso travelling 
to the nnclens elicit there similar changes which excite |min. and 
(tJirongh defect of the nnctenii) extend lioyond that i»rt in con- 
neclion with the irritated nen-e :^^r. it may be, from a disordered 
harmony between tliu nerve and its noelous, oortain nalonl mole- 
cular combinations produce a different and abnormal one in tbo 
naclenii ; in fact, a painfnl molecnlar arrangemenL In other words 
— Is the disease in nearBlgia oonfinMl to the nocleus, or ts the nvm 
lilcswiae affected, ho that, ia the' nerve itself otrtftia iiii|iiiiiiiiiiMj 
pndaec VDnsnal, painfnl, nolecnlar arrangements P ^1 

At firat sight it might appear that roost casca where injurr of one 
nnro prodoees nenralgia in another not anatomimlly related to it. 
as, for instiuice, where injury of the ulnar causes neuralgia of the 
fifth* and diiMMtM of the groat occipital, trigeminal nenmlgia, might 
aasisl as in Bottling this qnestlon. I1iua where pmsure or othur 
irritmtion on Uie wound of the ulnar nerve exeitm a Mrore psroxymu 
ta tlio fifth, it may be argued that tbe impression mtut produce bb 

' Ktsnlfk ul ili« flftli sArda aonBlimcs an llloilntioD of a anr* raiwhn scnnltfla 
■hOrt li ii Mt itMtr IW tMi nl |«in, (or wi «Ata bmI vlib ladat au wa| | U <1m U 
dMajad l«Mk, ibo*«li tU (mU U4uimIt«* sn fr«i fna |«Ib sad tis-lswws 



COC \IB S- IBRITITIOX. 



113 



abiunnal molocolnr iirTangetnRiit in the nlanr nnrvo !Uclf, sad tluit 
only Ihb particular tUTaofieKient is capable of exoitinf; pain in tli« 
rfftfa, for if irritaticn nf lb« ulnnr nurvo oxcitoi) only n natural 
ppMlectUM- armngeiaent, ne certainly should expect that the idtvntiL-nl 
sppticAtion to tho brnnchcii of tliir lifth nurrc wonlil induce a. 
p&m^trsm ; bnt thia expectation is unfiiltittod, for whilst preMare 
on the nltinr wnnml will excite the poroxyKm, preunire on the tenni- 
nfttiona of the fifth nerve produce no sach resalt. On the other 
luuid it may ho mid, that if the imprexxidn on the ijicAtrix of the 
ulnar nerve tudncea ati abnormal and painful molecular combination 
which cxcitoM nn identical armngumonl in the nuclen* of the fifth, 
jet Boraly the impression would excite & corresponding arranffonient 
hi Ha own nucleus and prodnco pun in the region of lliu nlnar nervo ; 
bnt this is not the caae, as the impression on the ntnar nerve in fi-lt 
in a natural degrou. The forogoiiii^ iiueriiiin tli«rcfore cannot at 
present, 1 think, be answered, but ite non-soliition does not affect the 
propoeitioD concerning the power of local upplicationn in neuralgia 
to modify the centra) molecular arrangement. To this snbieot, after 
the preceding rather long iligrewiion, I now turn to attempt lirst to 
allow that — 

By " local applications " to the trnnks or tii the enJn of norvea 
wo can prevent the paiii-givinf; niolecnlar arrangement of the nnalens. 
In the proviouH Kection we xaw that in ni-ntnlgia, and probably 
likewise in asthma, in megraioo and in epilepsy, there is an affec- 
tion of tbo central nervous syst«m whoreliy the impriusion made on 
the nocl«us spreads itself through or beyond it ; and thns tho 
nucleus, under certain irrilAtion, i» liable to aauiume a painful mole- 
oolar arrangement. This ei-rangement and consequent attaoka of 
paiu are gonernlly, if not alwayii, brought on by a distant local 
irritation oonreycd to the nucleua. Experience shows us that this 
tnorbid process often takes place, and we may fairly conclnde that 
it |>Tol>ably always takes place, for it is diflicult to undcrstiuid how 
any chaog« in tho condition of the oontntl norrons torstem from 
atatto to dynamic can take place spontaneously. Tho change mast 
be brongbt about by the effect of " imIatioD " condnoted to tho 
nnclons. No doubt tho pronencss bo an attack varies, and with 
neuralgia, epilopsy, asthma, and megraine, it oft«n happena that 
daring a long interval between the soixurcK, tlu: facility with which 
the dynamic changes take place in the nerrons ceutrea become in. 
ified, so that a very alight cause will precipitato an attack. 
ly removing the irritation, as by getting nd of nn irritating tooth 
neatalgio, the paroxysms of oounte substido, but the central con* 
dition i-enuiin« unaffected. Thrao cases Ihon we treat by searching 
ior tho exciting cause, and when this is undetectable, or when 
i I 



Kyi 
^pln ni 



Ill 



oonimit'iKiiiTiTiox. 



thongb detectAbto irromoYnble, loonl applications will yet do roach 
good, sometim«a will removA U>« irritnting ciinM, Irak oftontir hy 
i&flnoncing tbo centrdl nerrons disoase. Amon^ tbe nnmcnma 
flxampleii of tlie efficacy of local npjilicationK in oheclcing the pain 
of nennil^a, vre may instanco galvanisni ant) aconitia. Galvanism 
indnceii in tlio nDrrwt an altoreil molconlar arraiigemunt, which 
travelling centrally, excitos id the nncloaa a corrMpondin^ condi- 
tion whicli cfTncoi the niolcGular arranjiemeat, fprinfr riao to tlw 
sensation of pain, and snlnlltnting for it Uio galvanic seiisation ; 
and aconitia will in like manner pnxlnoo a jtecnliar and vlinnuttvr* 
istiv niol«i(!ular change, wbioh. replacing tliat prceent in the nuclvas, 
will change the pain to a tittftling aeoHation. 

It iv Nnfficient in moat caseH (o apply the galvaDtsu or the aoonJ. 
tia, Ac. orer the scat of grcattnt pain. 

Ttic! molocnlnr rhnngoa ao induced will aholiiOi the painful mole- 
cular amngoment thraai;hAut the nnclrnH and thns arrest paia in 
parta beyond the area over which lliese agents have been applied. 
Tlie tingling of the aoanitia or tho gatranie itenNntion w felt only at 
tbe part of contact, not over the whole of the painfnl tract, shuvrioff 
that, whilxt oontrotting thi? painfnl molecnlar arrangemonta tbrongb* 
ont the whole or greater part of the uucleusi the topical i^^ont 
il4N)lf indnciM only it» own peonliar moteonlar arrangvmeat in that 
part of the nucleus in direct connection with the nerrea to wbitdi it 
is applied ; affonling thai a good illiiKtmtion of tho fact, alrendy 
i>nUc«d, Utat only oertain imprewiona (molecoUr arranf^anuntt) 
hare the power to diffuse themsclvM throngb Um nnolens, in othn 
word*, to excite paroxyamal pain. 

In some ca«os, bowDVor. tho pain.cxciting oonditUnu are ntoro 
powcrfnt than the effouta prodaccd by tbe local medicinal appUfiaiioo. 
U may happen that disease of the nerve, or in the immodiata noiglu 
bourhood of tlie nmileuis or au improwhm oonveyed liy a norva 
Rnooanected with the nucluns may predominate over (be ofToct of 
the local medication, whi-n tbn |iaiii uitl remain unalti-rvd. The 
loual agunt ia then imperfectly fult or is vnliivly nnfott, or it may 
urvn incruaM the pain ; Ihne tt is well known that, nnleM it can 
■rapprvm tho pnin. modieatinn over thn territory of a painfol nenra 
is very tinporfiv^ll^r felt, llioflgh it must be admitted tluvt iRi|n«a- 
•iong nn the tomiinnltoiM of a iminfnl ncrvo are apprcciatod, 
though im]>tirfeotly. In a paroxysm of severe neoialgiu tbo tinnlinff 
prodnced by aoonita can ba discriminated even at the stst of 
pain, at least si> say ]«lien(s, iboogh tbey nay 1m< in error ami 
may attribute thv lineltng in a neighhonring twig to the implituttcti 
region. It is proUble, however, that imprevloiia cnn ba laft cvna 
over the scat of pain. ^ 



I 



COCinVK-lftBrTATlON. 



lis 



Kow M it i« impoMiblo that the skids moleonlc* thaald simul- 
tanoooaly uaanw different combinations, it foUowa firstJy. either 
tlist over n paiDfiil ref^on nil the tubnles of tho nurvuM un<] thuir 
ootTMpondin^ part of tlio nnciUtnii am not aScet«(l, that in fact )nrt 
of tlui BMdeotilM of the nnclona ate so amni^d m to ]>r«duc« tho 
BCnMtioo of pain, « hilst the rwt of tbo nnclotix remjuna in thia «-a; 
nnaffootcd bot bcoomco inflneaoed hf Uie loeal applicotiotin ; or 
Moondty, that different molecninr arraDgvnurats follow each otber 
In Tttpid nltoniAtinn along tbu Biinid n<'rro Knd oro Appreciated, bob 
Um int«rmis»iona beini^ ao rapid and brief, Mob noutioa soooaa 
ODDtiQiums. The local application hjr nmioriuf; tlie oentittl ooodi' 
tion cnaaing tbe nouralKtii, of vonrae prerontfl those seoondftt^r 
ofTects of Roorvl^a, which have boon fully dcmaribod, and tbn* I 
haw vbown timt *' Iocs] applications ntnir modify or remove diaooaa 
of tbe centml nervons 8jrBt«ni, and so removu or lemten the offoctx 
of the disease at a distent part." 

A»lhma. — The fbllowinff remOLrka ftre apptinlilu onlj to tliom 
fonna of asllima duo to aScotion of mnm part of thn nervoaa rjm- 
t«in. Asthma aiforda many instAncua of a diHtAnt local irritAtion 
oxcitiio; through tho non-oaii Bj-ntnm strong contntction of the oir- 
cnlar filircji of the liri>u<:hial tubes. These local exciting oaows 
may a«t throDgh partof (honneliin* of tlia pnetuoogRstric uerrc, or 
as Dr. Hvdo Snitttr ba^ sng(,>pstod, throagU tho pnlmonarr ganglia, 
the affection being aeated in nomu instances in part of Hut pncn- 
mogastric nooleiui, in otfaen in the pulmon&ry ganglia. Wlien 
food, coiiatipation, or ulorino diTungomnnt, cxcilo the paroxyna, 
the lontl rffi-ot mnst be traosmittod through tlio pnonmogaatrio 
snolens. Kven in bronchial axUima tho pneumogaatrio nncleas is 
probahif affected mtber than the pnlmonani' ganglia, for in this 
instance food aggravates the spasm and erea inducee it, tliougli it 
mnat be eoondontd that bronchitis prodnccH tbe disensa itsulf, for 
tliB bean^r absent food does not tighten tbo breathing. 

Tbe effieot of distant irritation tn a«lhma showa itMlf only in 
nnscnbr oontmction of tbe bronchi»l circular 6bres. I'robablr. 
the afferent fihmH atii] tbe nacleos can awume a great rarioty of 
molecular conditions, but no matter how niinMrons, snob will 
produce only tliis inrtii^ular moacular oontniotioo. Through any 
ehanga from the static to the dynamic state of the nuoleus, nervons 
force will pass along tbe aiferent nerves anit expend itself on tho 
nnaeles to whioh the aerroe are <listribnt«<l and tntuiw them to can* 
tract. 

la latlm*, h in nraral^ ih* snatominl <li»nit« murt be o[ i kind m labile tkit 
•t tsaMl, M frtmn*, •zyeot (■> dvtoct It u llie itiMucI nactem, vtilrb id«M alill 
rstsls lu or^niutlra mtklMij to anJnTi moIwuUf cbsngts is iMfmtt l« the 

I 2 



J 16 



COlSrJU-IltRITATlOjr. 



ncrrt*, tor i( the nuclaut intra diorKultcd, ihtat irtiUBti wonlil product no tSiMl ctt 
It, kod Ihtra oonll not rtanlt anj aiuiiin of th» lironclilnl tubn. 

Thcw ie in nuthmit, npjiarrnily, not iilmormnl, bnt riinplo excMsiTv 
action, Uiu nui:l«us being excited into undne action eitlior bjr cauka 
which pTodnce but little Bpa«m, or bj causes irhiob in lidnllli prodnco 
DO Rpajun At nil. Tliax. in broncliii^ Axt^mo, n mild attacJc of hron- 
chilis is snfflcipDt to induce p»vrer(Dl Hpasm, and as the hroncbitis is 
frcneml, n man tticrnnKcd sutwcrptibility of tbo nucleus, wlivrcl^ a 
sligbt excitant producioK «xocBsive action may conetitnto tlie wIioIa 
dJ«en»CL In other instances, howcvor, on iraprcasion conveyed to the 
nvcleiiB diffuses itaclf, and involrrM other parta of the nnolona. From 
th« ingestion of food, or thu presence of a fircal accumulation, or 
hcpatio doraDgtanent, on impressioD ia conveyed to the pnenmogastrio 
aaclenB. And thence extends until it involves the nndens proper to 
the long. Indeed, strange to wijr, the elfecte arn roflocled solely to tlie 
Inngs, and not buck to the stomach nor, as a mie, to that port of tbo 
nnclona appropriated to tlit- liMrt, thoogfa in some casus food may 
indnoe palpitation or irrc^utar action, in which case the longs are 
Daiially unaffected. Thu* we sec that the dilTnsibility of the afforeot 
impression, as in neuralgia, conglitnUis, at Ivout in many casos, a graai 
part of the asthmatic affi^tion itself. 

The local caowiUon of asthma through the nen'OUs ayslom is irell 
exemplified in cases wliero tbo paroxysm is induced by food, constipa- 
tion, at«rine derangement, emotion, and in the singular iwu) narrated 
hj Salter whore cold applied to the iniriep always provoked a sovere 
attack of a«thma. 

It is an interesting and important pntotical qnestion whether ibe 
d i se n ae is situated in the poeumopmotric nervous centre only, or 
irhetfaer there is likewise an nlToctioB of the ncrres, whieh unabU^H 
Uwm to propagate and convey the particular impression oompeU[^^^| 
to excite the paroxysm. There are reasons for thinking Ihitt in some 
inrtanwis there i* a itpectnl i-onditioo of the nerves : thus in the 
varum inctanco jnst mentioned whvro cold applied to the tniitep 
excited an attack, the cold would seem to have produced a peculiar 
molecular amng<'mpnt in tlu> ntrveti competent to excite tho par- 
oxysm ; for if tlio impact of cotd exoJted the osnal change in the 
afferent nerves we ftlwtuld expect that sold applied to other parte of 
the body would equally excite the paroxysm, for betw«on the afferoBl 
llta>vea of the feet and the pneomc^netrio nadous there is no ntoM 
oonneetion than between it nn<l the other snperfloial afferent nerree 
of the )>ntlr. 

In many caMs only a particular kind of impraaakm, or uolecutor 
shaage in the Amo nerve, will excite the paroxysm ; in eome onsM 
tpMaemnha or hay wilt excite a peculiar kind of Irvilatioo of the 



COU Xn £-1 BBt TAT I OK . 



117 



I 



mncnns membrano <vIiioli inducoa cli&ngca in Uie uorvus capable ot 
exciting tlio nucloas to tlio pni(]ni.'ti<iu of a pan>x}'am, whilst other 
IciiHla q( irritntion, as that from broncliilis, from cold, &o., tail to 
iodaoe a paroxism. 

Migraine. — 1 Khull have oc-caiiiou lu apeak uf migraine moch mora 
ConHsulf than of nonritlgia, since many of tlio commonts on nuuniltpft 
anil axthma are equally applicable to migntine. Like oearalgia and 
asthma, there is in this discwe an affection of tho centTal dottous 
Bjatvm, whivb, ho to Kpcak, remuna donnant till ronsed into action 
by Eomo " irritant ;" that is tiio affcciod centres oxiet in the static till 
stimulated into Iho dynaraio oondition. Owin); to the frreat varioty 
of exciting causes, opemting differently on different persons, chnngun 
take place iii a lai^e tract of the central nervona Hyilem, the extent 
varying in different individuals; thus, these changes may uommcneo 
in tbe centres for light, tlien radiate to the intellectual centres, the 
oontros for speech, and passing downwards and backwards, involve at 
lenglli the nnclens of the tifth nerve and the oontreH for vomiting. 
The symptoms of eottrse will depend on the regions aifoc^od ; whuu 
tbe centrex for night are implicntod there will bo ii]>(;ctm, &.a. ; if the 
ititellectiwl centres, then depressed mental activity ; thenucleuaof the 
Afth nerve prodncce saprn-orbital pain ; and the nuclons fur vnmitiug 
oxtiiea naosaa ajid aiokneait. Thogc are tho purtn niuitt frequently 
■nvotved. 

The distant effects produced by local conditions, generally sapra- 
orbiUil pain and vomiting, are well exemplified in an attack of 
migraine, wluob may be excited by intellectnal or emotional excite- 
ment, by straining tiie eyes, by indigestible food, by dornngcment 
of the liver, constipation, the calnmonia, and by derangement of tho 
womb. 

nitilat ou tbe one band contial cluinge« will produce distant elfoota 
so on the other hand the influence of local medicamonts in correct- 
ii^ tho central affection, and so controlling tJio attack, is v«ry mani- 
fest. On the commeiiMsmenb of the attack aoonitia or voratria 
ointmmt mbbcd over the seat of referred pain, that is over the brow, 
will relieve the pain and rcnlrain tho further extension of tlie central 
changes, and will prevent or check vomiting. 

In migraine acccmiKUiiod by dernngctuunl of the stomach, bowels 
or liver, it is often said titat it is useless to give medicines to act 
on tlMse parts, since these distnrbanceii, which occur only during 
the attack, ana prodDCcd by tbe affection of the central nervous 
system ; but if local applications to the scat of tho pain itaelf will 
amstboth this pain and the concomitant intestinal derangementa, 
there is no naaon why riemedios which may affoct the termination 
of tbe other sympathixing nerve, namely, tbe pnenmogastrit^ should 



118 



OOU!mit-IBiUTAT10&'. 



not modify the cliango in tlw nerronii centra likewise, so as to 
coalivl tli« eupca-orUt«l pain. In fnct, I hftTe do doubt Uial 
in oertkin cMCS, mnodiM which correct tlui gaMric, licpntic or 
intcstiiuki derangoment (aeo Podoplijllin), will oouBidomlily curtail 
thu paroxyMm. 

The influence of kwal applications on the c«ntnd ncrvonx aystetn, 
iji wclJ illustrated in some cawe of «pil«p*y praccded by an ttnra. 
Here ft local applicntion to the Mat wheoue the sum apiiorenlly 
dupitrta.arrMta Ube thrttttcntxl opileptto nttack. It mnj bo objected 
that the nura starta from the extremity of the uerre and trftrdliag 
to tho brain excitos the opilcptio ]>Aroxyxm, and that the local applioar 
tioii bj- aiTMling the anra prevente tho exciting cause of the opiteptk 
nttnck : but I believo it is now vwy goDcrnlly held that the aura 
itdL'lf dopondfl on. ocntntl ohanj^es, that the peculiar scnntion, an of 
eome imprMHion travelling up to the brain, mnvt be inoluded in the 
cMegory of roferml senMtioni. 

We m&y thii* oouoisely anmrnartM tho pieooding wiDewhat die- 
cureife argument : — 

Thu eontrni nerrouii aystem exereises a constant oonlrol over nutri- 
tion bimI »ccn>tion. 

Tho ncrvouH tyatom doen not merely ineTmae or loMCn wOTotioii 
and nnlritifn, but modifies multifarionsl j their chemical (molcealkr) 
cliai^gee,a« ■» inAi exemplified ^r}■ tint manifold iuflnonoo of neuralgia 
on sntrition. 

lly means of agent* applied t^t tbn jtcriphoty we can prodnoe to 
the oential nervous ijet«m cbangca similar to, or identical with, 
tboM which take place in neuralgia, and infotentially we can probably. 
is a similar way, inRnnnco nutrition imd secretion. 

'file natnni of tho ohsnge in tlie cvntral nerrons KyHtem diflen 
nocording to the nature of the topical application, and so its inflnenoa 
on nBtrition and aocration will Ti>ry, leading ua to hope that wo may 
baronftor ho ennbbd ta wloct a Rpeeial topical agent adapted to tlie 
|ndM distant effect on nntntion or secretion we may desire to 
|vodacc even on the boaltliy ncrroas Mytrtem. In disease of tb* 
oentral nerrous ^vtein, we can also influcnoo distant nutrition and 
■•oretioa, for in many ncoTons allectionH lh«ao functions boeoane mn<di 
BodiHod or eran sappressed. 

These sffsots, nsulting from morbid central ohangM, lopitial agenta, 
tbrongh U»«ir impression on tho afferent nerves, will dimiaisli aad 
•oiBSttiMa avni eradicate. Neuralgia, aslltma,migtaino, and apitepsy 
are iiutaUe examples of disease in which tho modifying and distant 
inflnaiicoof topieaJ agvnla on the oontrnl morbid uileotion is abon* 
danlty manifest. 

OmtharidM appliad to the surface of the liody eooa excitea tingUng , 



cODim n- mBiTATioK. 



no 



Botaiaig, and a sensation of heat ; the papillae of the skin quicklj 
becomo reddnoml itnd rauod ; noxt, in a iitriablo time dotenuinod bj 
tfa« Htruuprth of ihi? application, on tbeae papular elevatJona minutfl 
TCsii-lcH fotm, trhicb ffruduuUj Liilarge, and hy their lateral nctonsian 
Boon coalesce, bo as to form blob^ of varions siMit, filled with a fluid 
zich in nlbnmon, and geBcmllj cautainiug Komo St>rinc, 

It is of great importanco to bear in mind that the effeota of thE«e 
applicatinnfl aro vorj- different aocordinf; to wlu^thor extensive v«ic«- 
tioR IK prnilaocd or aimply reddened akin, with the fonnaticn of afew 
SKmII miliary Yedclee. Dr. Gmvf« inaisted on tbe different and ovon 
oppoftito eifcct of blialcm, according to tlie di-grue of thoir notion. 
Tbo primary action of a blister is that of a stimnlant to the body 
generally, and to th» individual orf(ans in whoBc neighbonrhood it is 
applied; bnt if allowrd to remain long enough to prodnco inucli 
vMtcMtion, and to form larRe bluba, it deprt«»eti iJie bodily powurci tu 
proi>ortiou to the amoont of Rcrttm withdmwn from the rossoU, and 
MO liMt to the lyatem, — a lowering efiei:t cftun exemplified in w«tkly 
people, who, through tbo abatrovtion of errnm. are apt to n'mniii 
weakened for Kuvenil dayB. Aa the Borum of bliHtorK rontainH uIiuubI 
as mncb albumen ns the blood itcttif, wo might as well bleed the 
patient to the siune amount, 

Shootd it be held dcBirable to reduce Bomewhat the patient's 
strength anil to prodnco simnltaneonitly a oouo tor- irritant cffoet on any 
of the individnal organs or tissues of the body, then a blister may bo 
applied, even to vocioiition; bat lu tbo good cEfuct* of blistering are 
for the meet part ensuTMl by a milder measure> treatment m energetic 
and BO dcpri-nxiDg is Kcldom called for. 

Dr. Graves commonly employed blisters as a general Etimulont in 
certain critical oanditione. In acute diames, a« the idiopatliio feveru 
and iiiflsumaiioDB, a patient, sometimes already ranch prostretod, 
drift* into a ilnngerouK. upnthctif^ and noobservunt fitatu, which ((oce 
on till it reaches ev«u partial iuaensibility or coma, so that ho can bo 
KHucd only with difficulty, and thon wmra a stunned, stupid, va4.-an( 
aapeotr nndorslandlng very imperfectly what ia Mud to bim. With 
this de]>reMKid mental condition the body genomlly qmpathixdK, iU 
fflucttons becoming more and more languidly performed, till thooo 
aMSMary to life altogether coaeo. It Is a condition which mi>y bo 
oompnrod, not inaptly, to that produced by opium- jioi»oning, where 
tlte partial coma prodooes a lethar|^-y in the functions of thn body, 
tluiir activity diminiitbe* as the coma continucK luitl deepens. Now 
a patient in the partially comatOBe state of wbicfa we are speakings, 
gets iK> trae luid n^frv^liing sloop; yet sleep is urgently nuodod, and 
an opiate and plenty of stimulants carefully given, often prodnco a 
rofreabing «lumber, ont of which tlic patient wakos strongthoni'd and 



ISO 



OODXTEIt'ItRtTilKMI. 



much improrisd. (Seo Opium.) Wlien the fnnctions are very 
lao^dly ixrformed this blisUtring Iruutincnt may well {iiooed« Um 
nso of opinm. 

In tLie precartotis condition, it in uwHTiitinl to ronae llie pntient 
from Ilia lellukrjfic atati*. 1'liia fkccomptitihod, ihv bodily functions 
will Bct irith ronew«d forco, nnii be will pa&i from inimincnl dutgtir 
to (XnnparatlT'e taidty. liargo blisters or mnsuird poultiMw alionld 
be applied for a h\\oH timu in qniok suL-oeasioQ to vttrionit psrtii of tJio 
body ; for inntAiicc. to the chest, tho abdomen, and to the tliif;hs and 
calves. Tlio grent value of SyiufC blitilvrs in tluiiw uircnmftauccA will 
be the better appreciated if we bear in mind that tlie critioal condilioo 
jitRt dcacribed generally occnre nnar thit «nd of an acntoillDOSS, when, 
if the patinil caii lie kept aliro for one or two days, tli« a«ar danger 
of doath passM away, scut« disoiwM baring a <lefinit« duratioD, m 
that if tbe patient can bemntaiued to this point his life may be anved. 
Conn tor- irritants, by roBsing: tli« patient, and apurriog Iku fiaegiDg 
titalityt mtj ruene an almost hopeleaa life. 

Proparationsof oanlhnridi» may he applied tw ittimutanta of special 
porta of the body ; for inHlance, ulien v< ith a funeral cotulition lifco 
that JDlt dcKcribed, them in four of hypontatic congestion of the lllBgai 
fir of pneumonia, io which such congoBtion often ends, flying bliiten 
applied Io the clic*t, and perhiipn, aa reoommvnded by Dr. QraTeOi 
Along tbe course of the poeumogaatrio nwvc«, may braoo up tbo 
tombU, and arurt a acriona and often fatal complication. Or we tnay 
simulate the heart, and in intense weakneaa stretigUien it* coatnt^ 
tions for a abort time, by flying blixtcra or mnstard ponllicea {daced 
over the precordial reKiou, and then maintain tlui ulvantagio tliu 
temporarily )cuined by tbe frett adminiatmliflu of alcoholic ttriokai 

Flying blister* an largely employed in varioiu diaoasca of tho 
de(-p-iMHtti.>d organs, oa plonriay, pncnmonia, aatlima, biliary and renal 
colic, &a. 

BliMers are frequently employod in pncnmoni* and ploniiay. Yet 
great divergoneo of opinion exiatB, not only as to the stage of tlie 
diavuMi in which they are oscfDl, l>iit eron aa to their utility in uiy 
oaae. Some maintain that during Ike febrile ulate bliiitvni iunrMae 
(he fevcnt ; biit the increase, if any, certainly ronst be rery slight, for 
I have not been able (o excite fuver in fover>froe)ier*on«by bltatOTingi 
nnr hare I ever seen it increase a fever already existing. The ndiro- 
cates of bliaturing in pneumonia maintain tbnt it removt* pain, quiets 
coDgh, anil lessens expoctomlion ; but many competent antfaoritios 
diaorvdil the efficacy of blixlering in thin itillnnimnlion. 

Wliatevrr ilonbt may piiHt lis to the influeticu of liliala-ring in aouto 
pDmnoiiia and pl^mriay, moat obnervon agree tluit itleaaena llto pain, 
Bad nmst (hcrvfurv benefit tlie patient by sobdning thn reatls 




OOmmK-IBUTiTlOK. 



121 



I 



oppnesion aud Hlo«p]«MneM oonaeqneni on paiiu In cKtimating tha 
effect of bltBt«riii)f, it must bo reooUoctetl Uikt iu tliew acute iJToctiniu 
the Mvere )»iii is of nhort donition, ftnd BpoDteneonslj' luMinu ur dift- 
nppvui in nboat forty -cighl bourn. It ia, porbapa, not suporBuouj 
to re-cantion agvnst too free vedbation. 

Opinion i» nioro agreod on tbo nsofulDum of oountor^imtation in 
ploortdj, after the Habudetioe of inflammation and fever. At tliis 
■lAgo tbo prompt t^plicntion of 1nrg<o flying bliaten, often repeat«d 
and qniokly hnled, farther the absorption of the fltiid in the pleural 
CATitjr, and iMsen the risk of the dixciufo niinuining indctinitclf 
chronic. The count vr-imtant, as we liave said, ehguld be frnjueutly 
appliod, and the Toeication, if it occur, healed at once ; for all the 
good of 00 uater- irritation i« effected dnring the first few houm while 
it alimulatc* tlto Rkin. The notion thatfrcw vcxicutiou and the matn- 
tenanoo of Uio dincbiirge by irrituting ointment will dr^n nIT ibe 
fluid, asii were, from the water-Uitfl{edpleunc,isaltogetlii>rfallactonii. 
This barbarona treatment <lrains inpnrtiuit nutritive material from 
the tjttvm and we»kens the patient wki-u strvngtb in moKt Deedc<l. 
yfe have already referred to the fact tlmt blinteni will redden and 
ereu infiame tbe pleura. Many coouder oonnter-irritatioa wone than 
useleas when pleDral effusion hoe fawtod a long time. The production 
of a free dischai;^^ of serum hi no doubt nseleaa ; bat although ia a 
long-atanding case of effusion Ibero ia but Klighi chnnce of improTl^• 
ment by any tr<?almont, yut mild flying bli«terti will in Momu oases 
help to tbe absorption of the llaid, asd at any rate may prore ser- 
viceable, if in no otlier way, by remoTing the troublesome tnterooatol 
paius which often accompiiuy chronic pleurisy ; altliough a mustard 
ponltioo is to be preferred. 

Counter-irritanta are often of signal service in removing tbe 
oppreesJon of tbe bnathing in asthma, eapooially of broncbitio 
asthma, and the abortneas of breath aoQompanying bronobitU with 
emphysema. 

They rvliore the pain arising from the passage of ranal and biliary 
caloidi. 

Counter.trritatioQ is useful in many other lUseaseB, as phthisis, 
ptiUbitia, aoiatica, facial paralysia, gleet, louoorthoea, rheumatiati, 
gout, and pleonidynia. 

Counter- irritation is very beneficial in certain forms of phthisis. 
In tlie luuto and rapid forms it U of little other eurvice than (o 
muove pain. But when tbe disease ia obronic, when we have to 
treat what is uow called tha fibroid lung, whtm tho cough is par- 
oxyMOal and violent, or frequent and distressing, preventing ia 
either case reet and sleep, aolive oountor-irritation of the chest, 
oomnpoiMUag to the seat of tbe disease, often quickly c|uieUi oough, 



122 



OODiTTBIl-IKMTiTIOX. 



gmtlf dimuusIi«B ikc profose oxpeotor»tum, and tbna [obviates a 
MTcni ttrnin on tho strength. In bJiBtering thotv «-oitk)>' pntienta, 
TMication mtut be aroided, or the exbaiution pnxiticed by th« low 
of Mrain iDftj bo BO groat u Arm to endnngnr life In phllii«i« 
ioiltu« Itutment is ft better conut«r-imtBut Umn blintvn. 

In inBoniRUtlion of th« BuperticuJ veins u blister appliM orcr 
tJi« conntt of th» i»lliun«d vcmoI rodaoon the inflnouiiKtion, lia8t«iu 
nb«orpti<in or liqneftictioD of the coiigDUt«d blood, and amisU ihn 
mtomlion of tltii circnintion through tho obtttrnctod veins. 

Blistering is of lfa« gmtest Berv'icc in n«aralgia. A flj^ing bli*- 
ter to bho tMople or behind thu ear g«nea*BllT reliovM fruntal t>r 
facial ncarfttgia. The obstin&te fomi of facial nenndgis depen- 
dent on a dijCMOd tooth, robelUona to alltnatmcnt exoepl uxtrac- 
tion, nften jHelda to a blister ; the nonmlgie painK i-emiing, allhongb 
the tootltAcbe majr oentinoe. Blisten relievo tlie sbiTting nenralgie 
paina common in nervOttit venxitivn womt-n, although the pain ta 
apt noon to Iik upon another nerve; bni flying blister* will drire 
it from place to places In thiK migratctry fi>nu the pein mM.j altar- 
natu between a fovr, or may affect in sacoesBion nio«t of the norYai; 
prodncing in addition great ontnneous tcndenteaili or the nervea 
mpidying the riscom may be affected, and nithont pain pioduoo 
functional disturbance, ae nanaea, sickni.'MN, ilinrrhtna, Ac. This 
fortn of ncarolgia, thongb it in right to uy the dioeaaa lixrkd many 
of the more diHtinotive chamctcni of neuralgia, la mo*t didioHlt to 
enn. The obatinate interootlal nenralgia left by shiogtoa, oc<mr- 
ring inodtly in old ]>eoplc, gencrnlly yichla to bliaters. AoBtJe 
pointM ogt that blisters applied over the a«al of pain aggmvale 
the Mnffering ; " bnt, on the other band, if tlicy are applied to a poa- 
terior branofa of the spinal nerve trank from yrbich tlie paiafal 
nerve iitoea, a reOex eRoat is often prodneod of tbe mo«t beaeBdal 
oharaeter." 

Blistering paper, although mild in Ita notion. re(|Qirtng to ha 
oppliwt •oiBo honi% generally prwtnoos enongh Irritation to relieve 
faoial and frontal neoralgin ; Irnt, if tho pain continne nnab ala d , a 
itmagec pr»pantion of cAntbaridoa abould be tried. 

Blbt«ra are of the groaleat Mnrioe iu sciatica.* Tboy aboold 
bo applied every day or second day in the neigh boorbood of the 
aoiatiu norre, reaching in eeveni eaaoa from tho buttock to the kaoo. 
Pres vcHication Mniotimcs auoowdfl 'vhere flight veaication hiita. 
Other ouunlcr-irritontB are n*efnl in nonrnlgias, oa mnatard jwul. 

* Ttf BMt eMiBkl* tnw ot tdrOiM mrt MHUaBM bMi6Ml hj lb* Iswrtion •( • 
u*db tor M Iwh (T nan la Mt w tee fk^ ***"€ ^ '»***' "^ t^ "^^ *"^- 
Kmv nIM bMMttiBM obuiaMl br dlMtat<M**nl h*'1m •• nouia jntwdil«l la Um 
iMraa* for bkU u kaor, •rerealMiiw. 



OOCKIVK-I HRITATIOK. 



133 



r 



lices, crotoD*oU linimeat, iodine paint ; bat cantharidee is superior 
to tliotn alL 

Bli8l«ra beliind tLe oar, ftnd espeoii^ly to the temple, are r^ 
UM-'ful iu rhonmntic, gontj' iinil £im[)]i; inflnmination of the ejc; 
rolioving jioiii quickly, and trnbdning iuflatnnuiti<iii, tliuuj^h leas 
tspidly. At it is important to repeal tlie Application freqoentlj, 
blistcrini? paper in preferable to Ktrongor pmpiuntiona. Obstinate 
formK of titioa tnrsi sometimes yield to repeciteil applicntions of 
flyiug blisters to tlio templos. Oonnttfr-irritatioa, by bliatorlng 
fluid or uroton-oit linimont beliUid tlie ear, ottaa ruiaoveis earache. 

Counter-irrituHon at tbo opigaetrinm oft«n allays pain andobsli' 
oiUa vomiting, due to disease of t]u> Kt<>miu:h. 

Mr. Famoaax Jordan employs counter-irritation to remove 
enlarged glauds. " In eutaig«d ^ands, in abaoeB, carbsnole, 
boils, eiyaipcliLM, tJio best locality for tUo counter-irritation is 
an>an(], or adjaoent to, tlur diceuic. Blisters or iodinu may bo 
employed." " In onlarged oemoal gliLuJii a lar;^ patob of iodine 
irrilation at tbe baisk of tbo nook, vrliiuli may be prolonged bolow 
tlifl glands, will certainly prove snocessfnl iu a short time." 

Dr. UcCoU Auderson recommends blUtoring in orytkL-mutooa 
InpuH, and iu clironic skin alToctioDfl, especially in eczema of tbo 
boudfi, when the tiKtuus, thickened and oiaoketl, binder free more- 
numt. 

In paralysis of tbo seventh nerrc, dependent on alLcmliona in its 
poriphory, from dravgbte or cold, painting tlie skin over the pant- 
lyeed masclus with btistoring flaid will in some cnsos quickly remote 
it. The eariier the npplicatiou. the gi-eater tbe probability of good 
Mialts. 

A blixter applied to the perinasum and along the courao of the 
uroibrn will oometimea euro a glost obstinatoly robollions to all the 
ttsual nidtiods. 

BlJKtcni are of tbe greatest service in rbcnmnti«m. Tiargo tlytng 
blisters, applied in proximity to an iitfliimed and painful joint, often 
quickly romovee tbe pajn, and with the cacc tlin* brought aUmt 
sleep often ensitoa, ftnd a conoumMit geueraJ iuipruremvnt. takes 
plaop ill the patient's condition. Ilut blisters have bo«D of old 
rwunimendod an tbo sole or chief tivntmoul of acute rhoumatism, 
and feomi) Apply tbem, to the extent of free vesication, with the 
tuif<rand«l hope of ranoring from the blood the poison on which 
rhennutism is auppoMKl to depend. This method has the disad- 
Toatngo of reducing the strength of the patient in proportion to the 
quMntity of aerum lost, tbo depletion lending to prolong the attack, 
uid to retard tbe couvalesconce, usually sufficiently tedious, after a 
■ovore attack of rheumatic fever, nliich induces more anosmia than 



121 



OOIIXTER-inB[TAT103r. 



moftl other dUcaaca. The advocaUs of froe vesication rsbsK thftt 
tbiii molhod inodornUot imil Kligrtvns tlic ntl4ick, luid leascnti the d&nger 
to llif hriirt ; tiDd noaie atiributu its efficacy to the infineooo luge 
blisten iukve on llko nriiic, cbanging id a fow 6a.yn the add arine of 
rhenmotia fervr to a neutml or ovon ft]k]UiiiC! state. I think thnt 
dno regard is not paidtothej^raat iuflnenoe ago I'xortNOnthedantioii 
of an attack of rlicainatic fiircr ; moroovor, the reporlcd cases appear 
not to have recovered more speedily than frecjacntly hajipunH In 
persona of the aome age, uid inanifuiiting the Mime body temporatura, 
who rucovor withoot any medicine. 

The nij^litly application of a nmall fiyint; hlist«i' greatly reli«vinth« 
pain and itnclling of chronic and siiLiacut« gout, gonorrho*] rhen> 
matism, and obrouio «yDoviUai bat if tlus wild application fail, 
stronft vmioation should be tried. 

Plenroilynia uamdly jielda to anodyne liniments or mild oonntcr- 
irritAnts, bat sometimes strong vosicalion is neoeMUy, although the 
weakening Iom of serom may incfowe the jiaJn for a day or twou 

It is sDrprising how miitrh relief a small blister no larger than a 
florin will often give in the furugoing diaeases. Indeed in many 
cases it is Ixrltor to apply a small blister nightly to adjacent part* 
mthcr than to apply a single large >iUj(ter. For the rdief of pain, as 
noomlgiji. pleurodynia, or spasm, as in asthma, &o., a bUator the siie 
of a flva^hiUing piece is generally eulB<:i>!iiU 

The aotivo principte of cantharidcs being solablo in oil) H >a oae- 
fnl to amear a little simple oil over the blistered surface. The oil) 
moreover, helps to maintain the plaster in contact with the skin. 

It moHt bo home in mind that blintering paste and blistering paper 
mqniro sevorat honra to produce n blister, and that tlui paper raraly 
prodnoM much vcnicntion. If a upccdy and sharp nutioii is neocssary, 
we muMt employ blislcring fluid, which sometimes resicatea Id twenty 
minutvH to lialf an hour. 

TImi active principles of the Spanisli-lly may become abear1>ed by 
the xkiii in ■nflioiunt (inantily to produce congestion of the kiilncyi^ 
strangnry, and its other characteristic tosio effects; heneoi in the 
treatment of aonte or chronic Bright'* dtwwse, eaatltaridoa sltouU 
bo avoided, as wo are snahlo to ngnblo tlie qoantily vrhich may h^ 
absorbed, and a damaging nmoont may be taken up by the skin. 

Wu hope it has been made Mullieivnlly plain that, in the irrunl 
m^rity of cases, preparations of oanlharidui shonld not be applied 
long eoodgh to oatiso mncfa vesication. The veeicles shonld not he 
0{MDSd( but bn oovvrtd with n layer of soft cotton-wool, till the 
fiBlUDd serum is abwrbed, when a eDperllcial desquamation follows, 
and no tmuMoaoinu oonseqnenoss need be apprvluindecl. If bliaturing 
is osrried far enough to prodooe bleba, the eerom will not bcoome 



OSTOIK. 



12S 



l:Bl>M>rbcd.ftD<l tho bleb will at last bunt; even in this ca«e it in not 

[adriaablft to open the blifit«r, bat to allow the nndcrlying dcmiis first 

[to bo*] pftrtinlly, when no nlccmtion ueed be feerod. If tho hloh is 

^panctnrecl, the air will perhaps irrilato th« raw snrfRco, produciu^ 

much inflnmrnntion, which may end lu cxlcnxivo Hloii^liing, rtn nD- 

toward event, cepecinlly apt to follow the blietonng of yonn^ children 

or old pcnpb, or pL-rxonx witli broken-down hi:a1tb,nM tlio victims of 

Bright's diaoose, Ac. Hone*, in anch cases, it is goncmllj considered 

advisable to nse otbor connter-irritAnt*. ( TtVi! llluiitard.) 




OXTOEN. 

hTOKie, a» yet, is but rarely employed in medicine. Farther cxp«ri- 
ueutatioD nwy perhaps show that it in n desirahlo thcmpentical agient, 
bnt at pncent the evidence to this elTect is looking. Tt has beeo 
rewimniendcd in the non-fcbrlk- (ormsi of phthiiciii tind is said to bo of 
of^kei'iiil KiTvico in deranf^ement of tho stomach of phlliisical piLtieuto. 
In inBammatory fcvon and fcln-ilu phthinis it is said to incrMLse tlio 
fcvor and U> favour lUDiDOptysis- A few speak favourably of it in 
phthisis. 

According to Beddoes (aid Demnrqaay, it is useful in asthma ; but 
they di^advisc tho tue of oxygen if heart diitcaea co-exists with the 
asthma. 

In anemia, from loss of blood or from suppuration, oxygen, aooonl- 
mg to some, increases appetite, stimnlatos digestion, aud imi)rove8 tho 
■tnogtiL 

Demarqniiy asserts tie romodial power of oxygen over some fonna 
Hof diabetes, and stnttn tlutt by moan* of this agent he hati rodaced 
Hithevngar in tho nrino by one-half; the diet romainx Qochaiiged. 
f^fione recoiumctid it in emphyaeoia and in albuminuria.. 

Thin pui in nsefal aa a local application to atonic poinfal sores, bnt 

•produces no oFIieeb on healthj sores. Administered as a gaseous hath 
for an hoar or long«r at a time, and repeated six or eight times a 
day, it is said to be of tho greatest use in senile gangrene, changing 
the Urid red to a rose colonr. restoring warmth to the tiaitiK'K, r«new. 
lag MDsatiOD, mitigating puin, obeckiug thu disease, and sometimes 
, sren caring it. 



IS6 



PEBOSIDB Ot UTDKOCEX. 



PEROXIDE OP HYDROGEar. 

PsRoxiDi: or HTmuxiiK hoa twrn need both intemalty and esteroaltf. 
It whit(!iis Uie skill or tuncAUH inembnuiuii, luul oxciUiM ft priokiDg 
aeuiiation, nnd, in dfticato etmctuivs, aa tlie coujunctiva, inilneca m 
tli^Ut cl«(,Tiw of iuflamniAtion. 

Acoonlitig to Dr. Stiihr, on adding poroiido of bydrogen to Tenons 
bloDtl, ]>rettj- adlru eServeaoeDim oooam Tlio aotatinu kooo boconiM 
yellowish -rod, then pal* follow, and in five or fiix iniuutes from lli« 
beginning of tbe esperimcnt, colourless, nml nfui-vrmnts » wliilv 
HoccnleDt coa^lum iwttl<;B. The corpuscles themselrva, whoa ti«aUNl 
with a strong solution, beootno irregnlnr in ontlinc, and do noi form 
roiiIi!itus. Added to pus, much giw is given off. and the nistun 
bocotiiwi tnrtiid with wliiti.' flocculi, and many of the varpoMlvs aj« 
HhrtmkoD or alUijjether dcHtroyod, 

A|i{ilic«1 to fthroded iinrfac<!!i, covered with blood or pun, th* sotntioB 
of {MFovide behaves in tbe manner aliove doaortbed. tbe nrface 
becomes nllinmtely covered with a thin Inyor of coagnlati'd nlbamcit. 
Tbo Bolntion. it is said, ni)l lioalachancrons son in half the onlinnry 
time, The Knre ui to ho waRlind with a solution tbnwi tiintv a day, 
and to be continuously covered with lint raourtened with it. Open 
buboes, ton, have bv<^ trM(«l snccearfally in tbo same manner. 
The solution is said to destroy the speoiflo chamoter of a chancrona 
eore. 

Intcmalty administered, it is ropntcd to be a diainfectanb aad 

ibt stimulant. 




CARBON. ANIMAL CHARCOAL. WOOD CHARCOAL. 



CiniinTC, in proportion U* iia poroaily, nbsorhe many gneos in ivnuid. 
erahlo ((nantity; and wood, liring more porous than animal aharc«*l. 
ile ahncirbability in greater. 

Charc<onl docs noi abaorb all gaaca in an ei|nat degree t it will 
absorb hut llltl* hydrogen, Utongh it will imhibo a iims)d«mMn 
amonot of oxyiten, a large (ptantity of sulphurretted bydrogm, and « 
■till gnater itroiHirti-on of nmniimin. Charvoal is mncli need on 
acoonnt of Ihis projwrty aa a dicinfinrtant, to renMve had smeUs, or 
to piTvetit ihv air in rooma beooming contantinatod liy the vfflsvi* 
from tnni ntcora. Its non^volatili^ renders it very inferior to 
ehlorinnti.*d limo or chlitrine {.its auil other ^i<nU for purifying air, 
■imoo it can act only on thu air in immediate contact witb it 



CaABCOiL, 



127 




^P It )B more efTcctujtl iu alMorbiog the offeiisiv« fpttea gircn nff bj' 
foul eoim, Rod in cmplnj-pd in the iarm of a ponUtcc, nixed either 
irith bread or linneed-tiieal. Bread, bring more porouii, is to ho 
prefciTwl, as it permitfi tho giMcs to pcniuMto the nbiitaiice of tlie 

•poultice, and ao to come into contact with the particlea of uliorcnnl. 
Aft«r becoming tlinrnngblj moiiitenod, and itii pores filled with 
mtter, U may ntoaonablj be donbt«d if the charcoal docR not Iobo its 
Cftpaeitj to absorb gwea and no tti act oh a deodoriiwr. It is certain 
that charcoal ponlticas often fail to act in tliis manner. Charmal 
Bi»y act by prevontinjf deoampoHtitm, for, vrhen swallowed after 
kdmixttire with water, its pores being tJios filled or obntmcted, it will 
stiil pravent flalnlcnce, nn ctffoct not duo to abttorption; it mmtt, 
therefore, act by arresting fermentation or decomporition. A 
thoron^hly ofGciimt mode of Mnplnying chnrooal ix to till a amall flat 
mmdin Iwft with iti in a finely granulated forai, and to phtoo it orer 
,tbe poultice covering tliu Hore. 

Charooal poultices are reputed, on doubtful grounds, to clean and 
• or gangrenaufl wounds. 

hi destroy Btnells deimidiiijr on noxious gaee« ? It 
Ihb been stated in a proriouspsge that it is endowed nrith thn property 
of condensing many gaaes in its pores, and some accept this as a 
sufficient explanation of it« action. Otliors amcrt that tho oxygen 
oondensed and aocnmalated iu the pores of tJic charcoa], combining 
with tbfl otltcr gases witli which it cuinea in contact, breaks tJiem 
up Mid destroys their ill odour. 

A question of morv ]>nicticid imjiorlniico is whether tho carbon 
booomos inert by use. thus losing its property to condense gaaim or 
to destroy thom. Bnchheim is probably right in Klating that the 
carbon becomes inert, but ollicrs nitscrt that if kept dry, it will rotain 
its proportiM unimpaired for many yeara. At all uvonts exposure to 
^_A dull red Iwat restores its gas^bsorbing jrawer. 

^K Obarcoal is lilcewiw employed as a dinnfcctaat, and Dr. Stonhonse 

^BluM ingeniously deviH-d a charcoal diainfeeting respirator, which, no 

V doubt, will protect the wearer against many gaaes, but at jiresiiit no 

evidence exinta to shuw that ebarooal will destroy tho orgnnic matters 

which propagate disnuV, although, acting like a tiltor, it may ])rf vent 

tlieir untnivce into the system. 

Charcoal, by its chemical or mechanical action, posM«sea tlio pn^ 
pcrly <if carr}'ing down from sulutious many colouring matlen, many 
hitler Bubstitnces, iklkaloi<ls, and mineral substances. Ueneo Dr. 
Qurrod adviMs ita admintstralion in poisoning l>y oorrosivo anblimato, 
nrMBic, morphia, strychnia, bt^lladnnna, ic, but, at prosont, this 
trMUmcnlhaa not found much favour with the pmfeasiou. Am it 
^^Upid tJlob half an oaaca absorbs only ooo grain of alkaloid, large 



1S8 



CHJLBOUl. 



doMs cE half an oanoe to an onnces or even more, mniit be ^von. 
CbarcoaJ alao preciintAtes the colonring matter of niioe, canriD^ 
dowu tit tli« Munc timo all tliA uric acid, ani! ttamo of tJio un* in 
aolntJOD. The anfciu- of diabetic nrino is unaffected bjr oharcoaL As 
n {irwripitant, nnimftl charcoal frocd from it« oartlijr impiirilira i* 
found to bo the inosi eSl<.'aoioas, on account, it iji nid, of it* num.- 
finely divided Htiito. 

ChftKoal is ompl(i}ed vfith much success iii ocriain di«MH« of the 
stomach. It is said to ease the pain of ohronio nicer, and of neutnlfna 
of the stomaob, posribljr hj checking formeittAtion and m proTcnting 
tbe fonnation of acids which mast irrita(« the stomach, cnpeoial^ 
when nlcoratod. It is markMlf useful in flatulence. In (h«! majarity, 
if not in all onscc intettinftl flatulence is Iho result of ^es generated 
by fermentation. The eymptoms aocntnpanj-inp flatnlomv. howover, 
an- nnl aInajH alike, nnd theirvarious complioittions afford indioatima 
for trealment. Somotinie-s "the w-ind" is producwl in enortnout 
quantities, with ^'at mpidily, prodticins dititension, erctctatioa, auil 
menial depression, the patient complaining only of thueo symptoms, 
not of (Miin nor of a«idily. This enormons production of wind, inw- 
speoUve of other Kymptoimi, prevails ehicSy iimonp middlo-aged 
women, especially at the changv of life. This coudition is met with 
E^.notimcH dorin}; prei^uaney and suckling, and iteldomor in tli* 
couno of phthisis. It is often very diflienlt to check the fonaatton 
of wind, but vcjicetablc charcoal is one of the bnl remodim. Some- 
tiiuea after a few mouthfnls of food the wind is formed in (juantitr an 
largo that the patient is constrained to coisoMkting; h«re (he char- 
ooal should be taken immediately before each meal. Another patimt 
is not Iroubtcd with the wind till bidf an hour or loiter after food ; 
here tlie charcoal should bo taken soon after the meal. Five or l«0 
grains of charcoal is genenlljanongb, and this do«e failing, it achloa 
happens that a larger ona nicceeda. Supposing charcoal to fail in 
eases like lh<«e just descrilwd, we baro another eflicient tasoBree in 
tbo nlpho-earbolates, or carbolic acid, which, indeed, often noooad 
when tho charccal fails. 

At other times profuse formation of wind is accom{ianied by acidity. 
Charcoal, administcml a« just described, will generally obvialo both 
thcM lymptons; and sidpho.carbolat«s and carbolio acid, alUum^ 
leas snccessfnl than when acidity is absent) will often prevent tlw 
prodnolion of both wind and acidity. 

Some persons after meals ara imnblcd with a Itttlo wind, aci<Uty, 
and a muatinn of weight at the pit of tbe stomach. Charcoal wiH 
relievo tfaeao casos ; Imt nnx \-oniica, in live-minim doaos of the 
tincltire, taken a ft-w minutes before mwls, is to be preferred. In 
the trvninent of 6atulence it moat never bo forgotten to direct tbo 



CABDOXIC icm. 



129 



patient, u fnr u po«Rikl«, to nbKtAio from those kinds of food 
prone to fermeniation. Bngar and starcbj- foods muxt ho avoided 
or tolcon Njiaringljr, nod thin well-browned tout, on acooant oC 
tile c&rbonizBtioD of its siirfacei may be mibdtitnicd for breed. 
I'ho tncalM oKould bn very modorato, tbe food well masticated, and 
drinking poalponed till tlio meal ia netu-ly ficislied, or, still bolter, 
till an hoar alter tt« completion. Tea ia vorj obuoxious to flatalent 
patients. 

lloat of tbo obarcoal pn«s(« away with tho fivces, though a little, 
it ia stated, fiuda its waj- iuUi tbe blood and Ijmphatic^s. 

Wood ig prcfcmblo to animal cliarcoul i'ur internal dbo. It is often 
adrantageously mixed with mi equal quautity of bitiiuQth, wbon flatu- 
lenoo ia combinod with acidity and pain. 




«Ji, 



CABBOXIO ACID. 

that thiit gas applied to the oye rolievea the pain 
of Rcrcifulutui ojibthatmia, and that injected up the 
TS^na il'^^^IB^ pain of clcomtion of Uio os atori and of canocr 
»nd neuralgia of the atems. According to Sir J. SimpHon, tbe in- 
halation of tliia gas is aorviuonblu in chronio bronchitis, asthma, 
and iiritablo cough. 

Car1)onio acid gas is ganeratljr employed disKolvcd in water. 
Katonl waton containing a lar;^ quantity of carbonio acid are 
used externally in chronic gout, chronio rheumatism and many 
chronio affectiona. Carbonic acid is an excitant of tbo akiti, pro- 
dtMnng tingling rednoss, a sensation of warmth, and iucreaiiitig 
ibe flow of tbe perspiration ; but after a time the gas ucIa in some 
noMnre as an aossthetic, leeaening the sensibility of the aldn, and 
removing or diminishing pain. 

Carbonic acid watvr is employed in painful and irritable oondilioos 
of the stomiK'h. It easeapain, and checks vomiting. It is an ex- 
collenl nilditiun to milk, which will then be generally retained, 

longb previously n>jei'ted. 

Lime-wat«r and milk may be proSlably stibstitntod for milk and 
Wrbonio acid water in diarrbcea with irritability of the tttomaoh ; 
tint in coso of constipation carlionio acid water and milk is mnch to 

preferred. 




130 



EULP&DR. 



STJLPHITR. 

Sri.pnrit <liMtc<l on the ulcin prodticon no ofTcci, but mixtxl with 
lard, or otli<>r nnclnons substancea, and rabbed in, it ezcit«s a §light 
de^i'cc of inflaiunuition ; lumcA adlpkar ointment bnii br«n nxod lo 
■tiraalate in(lol«nt Bores to n hoAlthier ftod more bealinf; Mndilion ; 
bat for sueAi a iiurgioHO ciore i^cient n^ntit luivo jrapcncdod iin]- 
j>bar oiDtiaoiil> which is now almost <intir«lf iwMrict^d to tbe cure 
of itch. Tho object iH to dcAtmy tho iniwct {aearn* neahiti} Mid its 
ora, for it is on the pro«ence of this Animal that itch depends ; asd 
It knowlL-i^ge of (bo hnbitJi of the acanui and ita ova KiiKg<Bt« tbe 
meuia best caloalat«d to effect this purpose. The female as aoon 
u imjnviiniXttd bturowR obliquely under (he skin, and day by dny 
depoflita her Cgifs till she dies. The male remains a vanderer 
on tho mrface^ and is easily nttaclcwl and killMt by the ointmmt. 
To roach and destroy a fem^e and her Oftffa it is necessary to 
break ap (be bttirows where those lie concealed, nnd Ut lay (hMD 
baro to tbe dtatnictive notion of the sulphur. Tlie d««tRiGlinn of 
Ibo burrows is easily offcotml by tke liberal dbo of snap Mid water, 
which rrnioTcs tho snpcrfSoial aud d«d outiele>, and OKpoM the 
aniiiial aud its ova. 

Vorioiis methods of sulphur treatment are tn ase^ but it is soffl- 
oiont bore lo record only a fow. 

H. Hardy claimK (hat hia method will cure in foor boars. Ha 
fint sabjoots the botly for balf as faonr to a friction of aofi soap, to 
cleanse the akin and lay bare the burrows. Then follows a warm 
bath of an lionr*s duratioo ; meanwhile the skin is woll rnbbed, to 
complete the de«tTuotu>n of tho barrows. Then tlte skin U well 
rnbbad all over — except tlie head awl tmcc, onleHi in tito rsr« in- 
stances when llivHi' parla are a(t»eki^d — with sn ointment oompewd 
of two parts of ealphar, one of carbonate of jwlash, and oigbt ol 
lonl. 

This rather sewre methltd not tuifrr^jnontly irritalca and 
tho skin, and is, tlierefore, imulvisnble fur delicate skinSt 
if much ecMmn or inSiimmstion is pmsont, iilTivtiiins which tU< 
vigomns tRnlnteul vrouUI tiudoabt«dly maeh aiti^ruralo. 

It isoften sofOciontto treat vigoroBsly only eortaiB parts nf 
body wheiK llie rash b most, appttrrnl, and lo apply Hut oEnt]iMnk< 
to olber parts in mlldw mannvr. 



SnLFHCB. 



131 



' If the skin is delicitte, much imtated, or iaJlameil, ft mili] soa,p 
m&y bo sa but) la tod for Koft utiup, ukI an omtnu^Dt, withont nllcali 
and witb lees enlphnr, while the time ef the applications ahoold be 
BfaortMiecI, and irwt^ad of odc oontinnouR sovoru appliciilioQ, tlio 
several w&shings and inanctiona should be repeated on BOOoeesiTe 
n^bt*. The niotraoat Hbonld bo left on all oiglit. 

Tha simple ointmeDt of the I'barmacopoeia. little irritating to the 
•kin, oontaininfc no potaafa or other alkali, ia in nietit inKtanucH Hiiffi> 
cient to cnre itch tn throe days. The patient aboald bo directed to 
take ft nightly worm bat)), and to rub tku tikin with mttp, bland or 
Btrt>ng, according to the condition of tbe skin. After wipin;; the 
bodf thoronRblj icy, the otatm«nt ia to be woU nppliud to the skin 
by tho fireside, jtist boforo bvdtimo, and to be washed off ou tho 
following mo ruing. 

■ The irritfttion sot np bjr the paifk«ito and its eg^ ezoites somfr 

'^iimea more or lea* coxema and impetigo. Tho troatnient ndaptod 
to enre tlio itoh would certainly ftg^ravate tboee accompan/inff 
eruptions. To avoid nudi a ooTapliuntiun, Hebru roconunenda a 
milder ointment of a difforoot composition; naniol; chalk, i m., 
■nlphnr and prepared tar, each € o>., ODraraoa eoap aud lard, eaioh 
a pound, the variomB oonstitoents in this preparation each serving a 
distinct purpose. The chalk helpe medianieallf to remove tliu dead 
ontHle and tc break np tho burrows; tho tar senras the twofold 
porpose of diluting the sulphor and acting beneficially on the ecxems, 
vhilo the soap and lard farther ofToot the dilation of the snlphur ; 
and the soaji, bjr virtue of its alkali, checks the weep'iiig from tho 
red, raw, omoniatons cmption. This ointment, ncooropanied with 
the nae of the wann hath, is emplojod twice a day, and uurca 

^eomplotely in ihreo days. 

^b A(t4ir the itob is oured, it often liappons that the mildest ointments 
«Scito and incrooM tlic ecxoina and other eru[>tiaDH prodnood bj tho 
•mbiefl ; benoe it is inadvisable to continue the nm of snob unguent 
lor many days. On wit)ibDldiii;f this treaiinent lUu raabc!* [>rodnoed 
by the seabiea will beqaently disappear at once. After the conrso 
the palie&t mn*t pnt on a:i entire change of linen, and the Koiied 
olotJbes shenid either be boiled in water, or heated in on oven, at a 
tuapemtnre above 212'' Fob., in order to destroy the animals and ova 
that may ho conooaled in the linen. 

Some maintain that the mljihurof the ointmeDt plays no part in 
tho ddNlmotion of the parasites, bat tluxt tite fntty matters, by ob> 
strticting Ihoir brcnthing pnrtu, stifTocate uud ao dcartroy them. This 
opinion Moms to be erroneous, a Rulplmr ointment being £ar more 
offuotoal than an ointment of lumplu fat. Sulplmretted hydrogen 
destroys lieo, and aemo suppodo that this gas is tho vfficiont iu:(ooli- 

K 2 



L 



132 



SDbPBTIB. 



oAk in cicittrof ing tlio developed ttoh insect bj tlie conversion of the 
SDlphur. 

Exc«pt in rare caae^ the oiitUneut ne«d not be applied to tli« 
hsad and face, for in tbin conntry tltctic pnrts ant not ofU-n nlfoct«d- 
1'bo dijtntjTeoable odour of the oinUnunt ma/ )» in part conotaled 1^ 
thu luiitition of otto of roses or other fragrant anbBtaooos. 

To avoid the disagfrevablc odonr and irritating eSect of snlphnr, 
ntaitj donaatologiats robetitato stonut, wbich is said to bo just as 
cffoctnaL 

The oomplexion of young women, in whom Hut monstraal flow is 
diaoHoFed, ia aometimoB spoiled hy nnmerons amall elevatioiu or 
pimplM, ecarcely or Dot at all rcddcnod, aod eomctimcs a miniite 
pustule on the amnniil of some of the elenUons forms, the skiu al 
tho same time losing its heallby transpanmoy. This is a fona of 
a<rnc pcrbapK, Uiongh uulike that unniniaiilir seen. Sometinua Uw 
eruption appears independently of monstrual disturbance, andi indeed) 
nay almost vaniah at the menriruai period, to rcour when it haacwaed. 
This eruption may last months, or tnea years, greatly to the patient's 
annoyance. It will, however, generally yield to the ap^icotioOi 
twi(<o or thn.li tlmM daily, of the following lotion : — Sal|>hnr a 
draehmi glycerine an oanc«i rose-water, half a pint. This lotion 
R]>eodity beneifita the eruption, even when for yoan it haa raoalned 
nninfluenood by other treatment. Acne may bo tiuat«cl Lo the 
samo way. 

An ointment oomposod of two drachms of hypochlorite of sulphur 
and an ounce of simple ointment, or ntpccially iodide of anlplior 
ointment, is very useful in the eererer forms of acne (nee SulpbidMj. 
They ihould bo applied twico <lttily. Where acne IndumtA is aooom- 
panlod by much acu« pnoclata frequent washing with jdooty of 
soap and warm water unll aiMist the action of ibem applioatioBs. In 
gonnine prurigo Dr. Anderson applies night and morning an oint- 
ment oompoflod of an onnco of sulphur, six dra«lims of liquid lATt 
•nd four onnoea of br-nxoatod lard. 

Being quite i&aolnbto in any of the fluids of the mootfa, aalphnr 
poaaeaiea no taste ; but as it often contains a small quantity of either 
Auljthurooa acid or of a sulphide, it may parUke of the Oavour of 
tbcM ■abetaaoos. It uoder^wa no ohaago in the stomach, and in 
DO way affaota the muooua membrane of this organ. 

In the intatlnei, howerar, the case is quite otherwise. Hera in 
ordinary doses culphur causes rumbling, alight oolieky paim, fol* 
lowed in a short time by a aoftenitd oracnation, aumetuiMu aocia 
repeated. From the ooonnwwe of oolio, and the somi>eoUd ooaditJon 
of the noUoBli it is geaendly bold UuU sulphur acts only slightly oa 
the maoou nambnno^ 1ml pnrgw ohiody hj ezoiti&g oonttmctions 



BBbPHUS. 



ISS 



I 



I 

I 



o( the moDonW coat of th« mt«stinea- From the mildnees of its 
operation it is ranktid amonff the Uuuttiveii. The procipittitodAulptmr 
being mora Gndy dividdd thiui tho sobtimod, acts mora Burolf uid 
•ffitotDAUy aa a ])urK<itiTi>. 

The too prolonged nso of SDlphur oxcitM & wtan-bal stats of tbo 
iDooooB meralyrane, and impairs digestion. 

Sulphur is a nMful pargntivo in piles and fiMtiro of llio tmaa, irhcm 
it is needful to Duintaio the motions iii a, soft and ytulditi^ xtutc, tm 
that the pMnge taay not lie irntjitivd and paintid hj haixl dtfBciill 
BtooU. It is a]»o employed in strictaro of th« roctnin. In habitnal 
or ohitinatc couKtipatioii it oftnn Kucceedii aftvr tho fniloro of other 
remedie*. The oomjionod liquoriL-a powder of tba OemukD Codax, 
which in prvfornble to that nf thu I3riti«h Pharmncopceiti, or ten 
grains of enlpbur mixed with confection of senna, arc couvouient 
formN. Compound liqtioricft powder uontoiiu both solphnr and 
sennat and is not disaf^eable. Ur. Ueorge Bird t«Uit me tliat 
childran like it, and that for them it la an uxtMillent pnrgntjvo. Th« 
doae for adullH in one to two teaspoonfuls atirred in » little water or 
milk. Apnrt from ite wjftuning uffeot on the motion*, eolphnr exerts 
a beneHuial action ou the rectum in prolapauB and iu piles. A 
morning dose of five to ton graimi of eulpliur mixuil in a drachm of 
confection of *«nna ia a very nBefol laxative is piles. 

What changes does sniphnr nndcrgo in the body, and in what way 
doea this dmg act as a purgative ? 

It has been snggcsted that soma of tho mlphnr becomes diBsolrcd 
In the fat it meets with in the intcxtiiitni, and thoj blended, is in a fit 
condition to act both as a pnrgattvo and to pa«s into the blood ; but 
tha foci that when tralplinr ig ndmiiiiKtvred Ktmultanconsly with much 
Hi, the qnaotity of sulphur iu the urine iauot increased, renders 
this explanation improbable. 

Some of tho sulphur, undoubt<?dly, is converted into a anlphide by 
tho action of tho alkali ofthubite; for after the ingcstioD of anl- 
pbor the gas generated in the intestines oontainn not only a con- 
aidcrsble qnontity of suljthurvttvd hydrogen, bat mncb of tho gns is 
givan ftif by the skin, to the extent even of tarnishing metal ai-tielea 
worn almat tha parson. Bulphnr nets as a purgative through oon* 
TenioB into a mlphide, and by virtue of the sama change it is 
enabled to mitor the blood, it view siipporlcd by the fact thab 
sulphidu* act in the »mo way as sulphar. Vet a portion in tho 
form of fine parliclMi piMhably puntDx tlimiigh the wnlU of the intes- 
tines undissolved, though the quantity so oonveyed is nudonbtcdly 
very small. 

Tho action of sulphur on the physical or chemical constitution of 
blood is at present unknown. It ha« been said to produce sali- 



131 



StLPBlDEg. 



ration oocuio&B.I)y, in pnmona who bad previously taken mcrcnrj. 
It w goneinlly held that it oxcitos an incmuwd Honrutiau fixjiu thu 
niDcons numbrimo of the ^r-paasagea of healthy persons, altbongh 
thiit in denied by Bnchhoim- Oravctt nni] other authorities Bttimglj 
recomm«Di]«d anlphnr in dunes of from five to ten grains, repeated 
thrM or four times a day in so^'<Tra chroniD bronohitia, with oAnaa- 
dant diMchai^ Mpud^Iy when aocomponied bj eonstitational 
debility. It ia said to Iwson tlu) aocratioD, and to rondor its axpnl. 
sion easior. 

It ia said to inoreaae boUi tho Eroqmmcy and force of the hMit's 
contiaotios^ Wid to promote the Bow of ]ier>ipiration ; but tJicM) 
UMrtiona greatly need confirmatioD. 

It ia bdiered that lh« application of snlphnr to the skin will rsliortt 
the pain of cbrouio rkuumatixm and Bciatloa ; but, aa >n api>]yiiig 
the aalphur, it i» ^noratly rocommunded to envelop tbu affected 
limbs in soft flannel, it ia dilBault to diaoriminato to what extont 
relief is attributable to tfao flanneL 

It is said that the intonud adminiatration of solphnr is serviceable 
in chronic oruptiuns of the slcin of the dartrous family, na acne, 
peoriasis, impetigo, and ecaoma. 

Uoil of the mlphnr taken into tiw stomach oscnpsa witli th« 
tec«« ; while pare of that which enters the blood, beoominp oxidised, 
appears in the urine as a snlphato, or one of the loww oxides oE 
Bolphnr. Thu snlj>huretted hydrogen, from its great volatility, 
eecapea in sone measure by thu lungs and skin, and oocadonally vr'itli 
tlu) milk, and by the urine. 

It iH said tbut a portion of the ingestod snlphnr passes throogh tlie 
^stflm and is separated by the kidneys in the nnoocnbinsd state. 
Sulphur praducM no change in tJio qnautity of tlie oonstitnents of 
the nrine, with tbo exception of the snlphnr compounds, which it 
angmeota. 

finlphnr may bo oonrenieDtly adminiateied in milfc. 



THE SLLPHIDK OP POTASSIUM. SODIUM, AMMONIUM, 
AND CALCIUM. 

Maxt nntnrst watort contain one or mora of these mbstanoe*. SnU 
phnrtma waters are found at Hatrugnto, BorAgea, Ac lliey hare a 
elianKtoristic o<lour, like tlut of rotten qggs. 

The three Arst labBtoooes an freely soluble, tlte last is rerj 
•eauUy solable ia water. 



luirnitiEs. 



135 






ft 



eolutions of tbeee soluble salu euccito actire inftammatton 
of tha akin ; wmJc solntions vtimolalo the skin, nngment its su|>plj 
of blood, Mill inorease peniiirotion. 

Batha contoining tbeae substances are very tuefnl in tho clironic 
of some skin dioMMMi, tt» psorioxiii, eusema, and liohon ; like- 
'i«e in ohroDJO riunnnstiani, chronic gout, and rlirnnio Innd-poiitoQinf^. 
Id these (Iis«a«e8 the nntnral tulphurouN waters nre largely need aa 
bfttlis ; bat in uoacnut and [woriuis care most ba taken not to umpkiy 
ihoBa till tiia BubsideDoo of tbo acute Hta^, othenviss tbey will 
greatly ng^irat* the roeh. Obstiiiato forms of thrso Fkin di»caM!i, 
robellions to other tre»tment, often yield to Nulphidc bat^. 

It has Ixwn attoniptod to explain tjie elflcaay of suiphnrona batliM in 
cwos of chronio lewl-poinunin^. by the iumnm]>tion that they eliminate 
the lead with th« Bivnvt. Under iho use of thrse bnthn tbp nkin, it 
is said, bccomoa covered with innnoietsblo blank poiuM of aulphide 
of lead; bat in liact tbolrad thus blackened bos boon dopositvd on 
the skin front esteRiul Honrces not oltminatod with the porKpiration. 
This ulij«(!tion, boirorer, is met by tho asiwrtion that if a l«ad- 
poiaoned patient catrefaJly abatninN from all contact with lead, yet, 
as often an he xism a snlpborouB bath, his body still becomoa 
Uaokened time aftor time. On theorotical grounds it is hard to 
ondemtaiul how this metal can be dtminalod with the perspiration ; 
bat for the further connderatioo of this point wo mnst roforonr 
readers to tho section on lead. 

I'he use of theeo baths at a. very high lomperatnro will often 
natoro ft considerable de|^a of auppleneaa to joiiila distorted and 
•tiftened by eJtronio rheumatoid arthritis. Yet m nthor baths of 
like tempet^tare ft]ipear to do equal good, it is ditBcult (o say wbetbor 
the mlphides play any part in the beneficial rosnlt*, altliongh, it is 
tmo^ th«i« is a wide-spread, and perhaps well-grounded, belief in 
their eSoaoy . 

A very ofBaJant application to onre itch is made in the following 
way: — Boil one part of (jnickltine with two of sublime snlphtir in 
ten parts of water, until tlio sulphur and time combine; l«t tho 
Bcdution stand, and afterwards decnnt the clear part. Metal vetsela 
should not bo nsod in its preparation. After the patient has bathed 
and wiped hinuolf dry the liquid solution is to be painted over the 
body. This application is rather irritating, and somotimcsprodncea 
a ruuffhnees of the skin, whi«:h may conttuuu some time. Ur. Uour- 
gnignon. who introduced Ihie plan, claims that it will cnro in half on 
bour, (Sec Stilphtir.) 

The sulphidM are in part dooomposod by the acids they encannter 
tho Ktumucb, ^ring rise to disagreoable eructations ofsnlphur- 
hjdiogcu gas. 




13G 



SCLPBtDSS. 



The sulphides in small dosos excite k sccsntion of warmth at the 
epigMtrium, but In exociwTo dow> they prodooe actJTo inflamiiMttion 
ia the digostiro canal, vrith the onstomMy njrniptoms. 

Smal] dosM act as a alight irritant to tjie inteatiora. and determiiM 
gentle relaxation of the bowels. It » nuppoced tlint Hulphnr acto as 
a pnrgatiTo, hy ila convcmioii into a nnlphide throu)-li tUo agonoy of 
the alkali of the bile. 

In awcx of peiaoning hjr certain metallio sails the Bnlphides are 
employed, as they precipitate the metal in the fonn of as inaolnble 
sulphide, and so render it harmleaa. Thi-ro ts danger, howerer, of 
giving the siilphido in loo largo a qnantitj, since in its tnm it might 
itsolf excite inflauinuilion of the atomat^h; wherefore snlphidv of 
iron is generally prefcrablo to the tUkaline sulphide*. 

The ofFcot of the mlphides on the blood after absorption into that 
fluid is at jtresent unaeoert&ined. 

Pcnon« lutl)itna]ly breathing air impregnated with sniphnrvtted 
hydrogen are certainly prone to HafFor from great antemia, and tba 
gas Bppcars to canae mneh fnnctioual depresaion. 

Taken in orer-dosoa the salpbid«« produce inscosibiility and speody 
death. It hu boon doubted, hoverer, whether thia rmmlt is not dne 
to the action of tbcso sabstancoa on tba stoaiaeb iteolf, and not to 
their absorption into the blood and oonTeyanoe to the norroiu 
centmi ; for it appvars from Bernard's experiinent«, that sulphuretted 
hydrogen injected into a vein in so qnickly oliminBtcd by the Inilf^ 
tliat the art«rial blood is anoon laminated by this gus, and conso- 
qnently the norrons cvntros cannot be affected by it. 

Theae sabatanoes, in oertain troublesome diaoaaes, often yield strik- 
ing results. 

This gronp of remedies influences the snppnrativo proona in a 
marked and mnntfoit manner. 

Thus the common case of a sore, discliarging a thin watefy. 
nnhmlthy iobor, will apoetUly undergo a healthy change under tbe 
aiimintatration of snlphides of caloiam, the diaohargo becoming at 
firat more abundant, aft^n-ward* diminiahing, itnd tlirongliout coa- 
tinntug thicker and healthier, with all the obanoten iudead of 
*■ lan<Ubto " pus. 

The anipludea ajtpcar to me to possess the property of proTeDtiag 
and armtii^ suppuration. Thnu in inflammatMO IfaraatOBiag to «nd 
in «u|>panttion they reduce tbu inflanimatJoni aad avert tlie fcmnatioa 
of ptiB. Tliia effect, for inotanoo, ts iniuiift'Jilcd by tlw aetion of tlw 
local applicalioa of snlphnr oompouiida in acno indnraia, a snbjHil to 
1)0 dwlt with further on, more in detail. 

After tlio formation of pus, the inflttenea of thin group on Ibe 
nppiutttion pcooeia la atill mora oon^Umons ; then the mlphidia. 



SULPHIDES. 



137 



ba«ien raatnmtion conKidornblr, wbilni at the same limo thef 
diroinisli and circumscribe the inflammation, promote tlie paMtgfi 
of (lie pun to Lbu tiirFiuic, and tlici ovncuntion of the ahsccss. Thoir 
efficacy may be fraquently domonstratod in cases of the following 
kind. All unhealthy obild, from six In twelve montha old, perhaps in 
tho coarse of me&slos or scarlatina is the subject of a i>tight mro. 
throat, which jiniilttoi-M IwUind the angle of tho jaw eonsiderable 
w1arg«moiit of ihoglaiuls, and the swelling, of stonj bnrdnoM, m&jr 
be Isrgo enough to iuterfere witli Nwidlowing, and even to push the 
licwl on 0119 sido. Very deep-seated sappuration talcos plaoo, luid for 
a loaiT time there is neither redneu of the ekin nor flnotnationt 
ftnd (ho pus rery slowly makes its way to tbo snrAtco, so tint a fort, 
night, three weekc, or even a month may elapxe hefure the absoeu 
borstM.or is fit to be opened, when a doop holo is loft, with consid«r> 
able uulumlionH aronntl it. So groat are the ])ain and (^ouHtituliunnl 
diitnrlMuico tliat the child sometimes dies ; nnd ovod if this ftitality 
be Averted, tho deep disclmrging holo heals very ahnrly owing to 
th» indurat«d and luibealthy stato of tho adjaoent tissues. Now, in 
noh ft testily oasoi, if wo give a tenth of a gmin of imlphido of 
cftlcinm, raixod witli a |^i& of Bogar of milk, overy hoar or two, tho 
tesolts are uioxl inking. Tbo pain and conitlitutional disturbance 
begin to diminish, tha swelling becomes smaller, the pus reaches tho 
sorface in four ov five dayK, loiiving whun it is evaanated a benign 
wound which quickly lienls. Tbo effects of these remedioe are 
equally conspicuiinit in mivmnuiry ahuaoxsciH, although in nuv inslanuON 
they appear lompomrily to incr«iBso the pain — a, fact which seems 
someiimea to bold good with respect to boils, tbooffh as a rule tho 
|)«in in Hpopilily mitigated. Sinjimlnr to say, I haro found tlwso 
remedies much less uxuful in forwarding the mnlamtiun and expulsion 
of pns in indolent bnboes ; but in such cases my experience of tho 
>ulphide« baa been bat small. 

It may bo nrg«d tliat it is difQcnIt to imagine bow these remodies 
eaa prodnce cScota so dilfcrcnt and apparvutly opjiosilo bn the dis- 
pereioo of inflammation iu one ease, And tho expulsion of pus in 
another; pouHioe«, however, an<{ lint fomentations bcith iiubduo 
inflammation and prevent suppuration, and inothercaseiscousidenibly 
liesten the evacuation of pus. 

In boils and carbouclos these remedies yield excellent rcsnlts. 
A tenth of agniin of r>ulphide of calciam, ^rrn hourly or every 
two or three hours, will generally prevent the formation of fresh 
boila, while it lessens thv inflammation and roduoos the area of 
wdeting boils, and quickly liqneBea the core, so that it soporatoe 
mnch more s[iccdily. thus considorahly cortailing the conrae of the 
. boil. Whcr« tbe skin is not yet broken, and the slow -separating 




138 



SUU^IDKS. 



oor* nut jet «xpci»e<i, the sulpliidaa often convert Uie boil into An 
nbacoBS. so that od bursting, pna U froolj iliicluirged, uul tlia vound 
at onoe hoftla l or if the ceuLre of the biurdenmi swollen tlscnee is uot 
7«t dead, the pustulo dries up, the infiunmation snbeidiM. and & hard 
knot is left which liiwipjxsirH iu a few days frithont tha fonnatidii of 
K oare, luid willioui any diKcbargc. These remedies mowtwhila 
imptoro tho gvnonkl hiailth, nMiu(via{( that debility iini] maltttM 
ordinnriljr bo m&rkedly associated with boils and c&rbuncles. In 
some oases, howover, oa in the doep-eeatad boils and abaosasvN of 
dlabctcH, ihej ore less offioocious. Id c&rbunoW the sulphides will 
goaienHij bo found eqnallj sarvioeable, niellin|;, as it wore, tho uoro 
ioto healthy pas, and so <inickly cxpirlting tho dead and othwvriae 
aiow-sepaiuting tisme. BoUndDtina apphod over absoossus and car- 
boDcliM rftdnoes inilainiaalioii and oIIajs piuo. The akin should bo 
thiirk1;r ameorod with uqoal pai-tti ul belladonna and glyccrino, and 
ovor thin a poultJM sboald bo applied and the smearing renewed each 
time the pouldco If changed. Poultioes, however, buing lialile la 
faring out a fr«h crop of boils, it is well to smtoir belladonna ointnienl 
some distance round but nut owr tlio Irail, and then to ajiply • 
ponllioe, the grtiasy application thnn protecting tho neighbouring 
tissnos. Or, rtill better, apply a belladonna or opium pliutor an 
leallier, with a hole tho site of tho boil, around the swelling, and 
through the opening smear glycerine and bolkdonna, covering all 
witli a small poultico. Tho Icntlior plaster vflioiontly protects the 
■urroundiug Ekin, and nverU tile produotion of fresh boilv. 1 hnvo 
thought it worth while to point out these nsofnl acoeaeot^' plana of 
protecting the boil; but it is scarcely necessary to obeerva that 
wkihit inrestigating the effects of solphides, 1 havo employed them 
■loni^ or at moat sometiisM asing only a pooltice. Indeed, the 
flffsct of tutpbi(lc!4 on boils is ta excellint and prompi thai 
•Xleroal applic^itions are gviwrntly unnoccmuy, though of ooiusa 
bbey are required in the treatment of carbuncles. Sulphides should 
ba continued till the discharge has nearly oeasod. and till slimn* 
latiag api'licatiuiis are neetled, when totiios maal teplaoe snlphtdea. 

The good ellocts of snlpfaidea ar« oonspionous in cerloin scrofnloaa 
sores not uncommonly seen in children. Sorofulons children daring 
the first few lannths aro sometimes subject to indolent absosasea in 
the oelliiUr lissae which ran a veiy slow euunw. At linit only small 
Itafd sabataiicui arv obscmble, no larger than a pea, ttnder the akin, 
wbioh is of natural colour, and movable over them. Tho snisll 
nbstaacea naxl suppnrate and grodnally enlarge, the skin bscomsa 
adhersBl, and nhaages in colonr to red or even violet, while tfaa 
smaller vessels in their neighbonrhood sometimoa become cnlotgod 
and mtn vanooee. The tnmoan may atloin tlw fixe of a Oiotin, and 



SCLFBIDEB. 



139 



ythen muixmlcA feci Koft find bogjry- Aftor a time a Hmall circiUnr 
Oiwning appears, not laiKer, {lerhaps, than a pin's Iicuul, through 
whuih Micapc* a thin nnliuJthy piis. If diwp-ncalod. ■» on the 
kntUtcks, or occorriDg in fat chiUren, th«M may be voiy Htllii or 
no diwxilonttion of thu «kiii. Tbo diiof notioonbUi cliaiuotcr, lUim, is 
the «mal) sluu-ply-cut opetuof;, an if a piece had been punched unt. 
Thaso fonaationa follow cue anoilier, and maf continao to di«tr«M 
tbe vliild for montbK or yrara. In mild ca«ci a iov only ma; fonui 
whilst in ftovcro cases tbera may bo at ono time t<m or a dtmcn 
in different etag«s of dove lop men L Wlien tluiy heal they loare a 
white, xharplj-dofiued, but. not Ucoplf-depnesod war. Kow thui 
tn)iiblesom« and poriin&cions condition will ^ti> waf Bpeedily to 
the adminiatralion every bonr or two of a tontb or twentieth of a 
gndn of Nalphido of caloinm. Thu fiirmatiou of new nodulea ia at 
Mtcv chocked, for a fresh one rarely now makes ita appcMmnca, 
allhun^^h for inontha or juarit llio cliild may have been infested 
with succesaive crops ; many of the abscweee, especially in a very 
early stage of dcrotopmcnt, di-y up and <3iiiponie, othera genendly 
Speedily maturate tUeir oonlents, tbe tbiu Eind unheaJthy pus bocom* 
in^ oreamy and " laudable ; " iho abacussus aln^dy in iin open state 
tmprore, the pos becoming healthier, and tbe wounds healing ijnickly. 
In aonio cans, in addition to thosu subcnlaneous fomiatiouai, the 
booea likffwiso becotoe alteuted. The phalangeal bones of the band 
are moat freqnentty attacked, though not uncommonly the metaearpal, 
and more rarely the metatarsal. Where tlie phalangeal bones an 
aiTeoted, ono or siircml of the lingrrs boconui nodoae. For a loo^ 
while tho skin remains ])ale and freely movable, bat then snpparatioa 
ensnea, lliv swelling incrvoscs, tho okin bocomos red and painful, and, 
after a time, slowly softens at one point, remaining boggy for a con- 
siderable period before tho nfasc<ws 0}>cnn nutumlly. Then genenUlj 
a little bono separates, or iu bod i-aties the whole of tbe shaft oomw 
away, leaving the epiphyses behind. 'When an opportunity ocoura to 
examine these bones before Kugipumticm Mtts tu, the dhaft is found 
Gonaiderubly onIarg«d, very pale, and the cancollons stniotaro intil. 
tratod with a straw-ooloar«d firm substanoe, whibrt the epiphvHcs and 
their cartilageii are healthy, Even in tlieso sorore ciiM« the anlpbidca 
will hcnoilt oonsideiabty ; tho* Iwforo nu|iparati<in ban set in, or wltilsb 
it hna muilu little way, thoy oft«n remove (ho swelling, though Inrgs 
doM-H may bo required. After much soppiiration, th<! |^d eSeda o( 
•nlphides depend in a grttfit meaaure on the amouat of tbe diauasu o£ 
the bone. If tbe whole shaft becomes neoroaed, of coiino the aore 
will ni>t heal till the bone has been got rid of; bat sappumtion oftsn 
oocnra and yet but little, or perhaps nonet of tho bone diea. In snoli 
a case tho salphidea haaten the expulsion of th» pns; and whua the 



140 



EULPBIDEa. 



skin ia klrendy broken, tliojr improrc tho cliaitict«r of tbe wound 
osd tko diaobur^, and be«l tbe won, leavin); » Bunkcn ecnr adboront 
to the Ixtiut, whilst tho finger slowly usqium it« natnml proportions. 
The solphUlos Mimtlarlj aBieot larKo indolent abBoeases on the bock of 
tbe bands or on tbe feet. Whilst tbus influencing locnllj- xtrumou 
formations tuiil absooBses tboao remedies improre the cbild'a health, 
which perhaps had failed before in spite of cod-lirer oil nnd slool 
wine. That tho improremoat is doe to tbe sulphide is shown by tho 
(act (hat tli<! amL-n<lmvnt ocenrs when this dmg onlj is administervd. 
Sometimes, inatewl of improving the g«ni.T«1 hcnitli, sulphides pro* 
ditce marked WMcmio, dac, 1 think, to iho adminisuatioii of too lurgo 
ft doee. On pranifttniely discontinuing tlio salphido, fresb formations 
tan apt to nppoftr, ospcwially on the oceurreoco evon of a slight 
illness ; indeed a severe illueas will oftou excite a few fresh abso e a o e a , 
iu Kpito of the snipbidee. 

In snppnratiDg sorofiUons glands in tbo nock, the mlphides appear 
to DM! to exorcise ft verj- benelleiul infinence by liast«niiig tlio elimina- 
tion of tbo pns, and BabvDqnently the cheesy sorofulons matter. 
After tlio abnccsscs have borsty and oontlnne to slowly discliargo ft 
•canty, unhealthy pus, and when tho edges of the sores haro bocMBfl 
much thiokintcd and indorated, tbe sniphidcs r^udcr the diaohotf;* 
more nbnnlant, thick, creamy, and bmlthy, connidorably bacten tbe 
eraonalioB of the sorofnlouH matter which prevents the healing of 
the wound, and at tbo same time soften the ronnd indanktod edgoa, 
so that the aorc hoals maoh more Hpeedily. If small doses appear to 
affect these sores inadequately, larger dose«, as Itolf a grain ca a 
grain, should bo given several limes a day, or even every two hours. 
I seed hardly say iliat to oompass the resnlts dewribod tbe tmat- 
aent mnsi Iw oontlnaeil sevend weeks, for when the sores have boon 
diMharging porliaps for months or even years, it is vwn to expect 
nnob amcndtixint in a few days. 

Tbe topical ofTvet of sulphur ointment, or of an ointment of tho 
bypoohlorito of snlphnr, or, still bettor, of tlu) ixdtilo of salpbnr of 
the Phonnaoopoeia, is very marked on none inilatala and nonn 
rosaoeo. Hero, again, according to tho stage of tbe eruption, (he 
«Soo4a are twofold, and even opposed. If applied at the very oom- 
awBOamsat of tlio emption, ns soon as tbo little banl knot is felt 
nnder tlu skin, tho ointnwnt arrusts further dovidopaunt and 
qnickly dissipates the hardness. Kor instanoo, if smieared over Lho 
hardneas just before going to bed, scaroely any induration will be 
felt in the moming, though after a time, porhapa from exereuM, or 
tbo irritation from waahing, much of the liardness ntay retuni. to bo 
affaiu mnuvi-d by a renewed npj>lica(ioD of tho oinlment, so thai in 
two, or at most tbrou days, it will completely dispow ft ps^mlft 



I 



4 



CBLOniXR. 



141 



ch Uiroatoned to becoma of oonsiderable size. When, however, 
th« DOdule Uaa mlraDced furilior, und STippuintioo tns set in, Uten 
the effect of the otntmoat is much like tbat of sulpliides lulminLs- 
t«rc<l mtvrnallj-, on koilN. Thv ointmotit bftatena nuttiratiou, limits 
Ibe swelling and bnrdnees, and tbns considentbly curtails thu diini- 
tion of the eru[>tiim. Naj, furthur, if rnbbud ovur tbe skin it 
appears to chock tho formation of tLe acne spots ; rabbed over tlia 
noBO and noi^hbounng parts of the face in ocno roxncon, its flSeota 
are oftea striking. Not only docs it act as in acne injurata, bat the 
hardened, swollen tifisneB become tntUiucd and rudacod to a more 
natural state. I have found the iodide of salphar useful tikewittci in 
bromic none ; it roduces the eruption, or, at loaat, lomoiis tho sizo of 
(•oh spot coDsidor&bly. Tlie ointment should be thicklj smeared 
onr the eruption of acne iiif(ht und morning. 

To odolts Bulpliido of calcium is beet administered in a coaled 
pill ID quarter or half gnun dones, tlireo or four times a dftj. 
For ohildren I uso tho followiu),' tarmalie: — Mix a grain of tha 
sulphide of oaleium (the mumbur of thin group wliioli I ulwayo 
«iDploy) with half a pint of water, and give to a, child a toospoonful 
hourly. It i* ctuential that tho mL-dicinu in thin form should Iw 
compoundod daily, since the salt rapidly becomes oxidized and 
changed into a snlphate, so tliat in u. very xhort time none of the 
snlphide remains. It is still more convenient to ^ve the sulphide in 
powdar. A child should tuku uuu-t«nth or ono-tweutaeth of a grain, 
■nd the powder should be put upon tho tongue and washed down 
with m draught of water, or a tenth of a gntin mode into a small 
Tanushcd pill, fhoiild be tnlci^n hourly. 

It eliouhl be observed that) in employing these agents in l)aihs, 
porcelain or wooden vesiwls muirt be used, as tho sulphide attacks and 
diaeoloun most metals. These baths emit a powerful odour, veiy 
(ifTonsive to some people. 



CHI-ORINB GAS. 
CHLOKINU WATER, 
CHLOKIXATKIJ SODA 
CHLORINATED LIME 



and tboir solutions. 



TnnB Ribstatic6Bi are nsed as disinfectants, antiseptics aod duo- 
(Iprixen. 

This actioD depends on their power to destroy the organtama that 
pTOdooe putrofactioD, and those that produce the toptiu poison or are 
UumaolTos tba eanse of specific fereK. 



142 



CHUHtlVB. 



'niifttoTer power thej poesem in th«ee mpecta is dse eitlier to 
oMoriBO or to faypochloroB* ncSd. 

Chlonne gaa, poBsessing Ti>ry strong obaoiea] affiuiliee. acts |iro)». 
tbiy bjr MJcing iriUi avi<IUj tipnn tlin h^rogSti in orgnnio and inor- 
gittiic Hub&tiincce, thus breftking ap tboir composition. 

IIjrpochlonmH noid, wkicb is given off abtindiintlj by thd two hut- 
roentloned members of Uiia group, is m actiro oxidiKinf; a{[mt. It 
yields np its oxjji^n reftdily, and is thus destrnotirp to niKtijr rob* 
Btsnces; at the mtnc time flilnrino gu is set free, wbicb in iU tarn 
acts in tb« way just described. 

Tliese enbfitancra arc tlioniforo doodoriscn, destroying* Ibe aau 
nonius, snlpbnretted hydrogen, and snlpbides of nmnioninm, which 
cmte the disitgreoibls odonnt of sit-k rooms. 

Owing to it« gamoas state, cblorine it admintbly snitrd u ft de»> 
dortior; it pcnotmtee irvnnf cmnny of tbo room, eearobing onl und 
dMlroyingiKixiotiaand olTensiTc gases. 

niiile tbcee snbrtances nuky bo cxmTeniontly and proftlably nanl iw 
dendnrin-m, it mnat always be borne in mind tbnt it in bcltt-r tn pro. 
Ti-n1 luut smells by hce rontllfttion, nnd tbat ohlnrine gas ilevlf Iuim an 
odonr very diangreeable to most people. If ibieae deodflrixom arc often 
required in ft tti<^k room, it i» »Bnre irign that TCntitation is dofectivet, 
unil probitbly tbat the nnrso is c*rc)c6s. 

Tlioso Kubslanns nro «inploy««I lu dixinfoctants, bnt tboovidvnoe 
in fftTrmr of their poweadng encb n property, altboogb vety gemenlly 
held to be snfflciont, is ineonoliuiivo. 

Some infecting nattent, it is tme, when treated with those mib- 
etanoes, lose their power to jiropagMto disease ; bat it is impoasiblo 
to nliject objects, Wtd particitlarly iwranns, to inich dcHtmctiro action 
■a is (oniad to be reqaired in thoiw ex]XTiment«. 

To disinfect nnonrupied rooms, the air must be vi^rf stmngly im* 
pngnated with chlorine. M. Itognnnlt reoommeDds the followiaf 
pka, first hloddng the chimney and closing tlie room: — S«w ooo 
poond of chloride of linio loosely in » strong canru ha^f, and put it 
into a mixture Moposcd of a pint and a ludf of oommuvial hydro- 
chloric aciil with four and a half pintu of water. Then after twenty- 
fonr bimr*. freely ventilate the rooui for forty>eight honn. 

Besidea their capacity to destroy many offensive gases, these sab- 
•taBceapnvDBt deoompusttion; henoe they are nuL-tal as wnahoa or 
injeetiniM to prerent tho deeompoeitKm of tlte pus of norot, nr oavitW 
of Uiobody. SloQgfiing, fonl-smelling sores, ahoald bo washed witli 
•olstions of Umm or ot^er kindnxl salMtaneea. Chlorine eompevMlit 
baing dightly etfanlaliiig, improve tlie eondilion of indoleat sores. 
Attsr an opontJon, the pns wbioh sumetimcs (^IIm^ in llic bollnwa 
lafl boconea cormpt, and give* off fwtid gas which becomes abaorbed 



nod poiaana the gpAem. Tfaia maj' be avoided by ivashing oni Hie 
cavitim hotcta] timoB tinWy with ft 'trunk clilonnc solution. In pttcr- 
{lemt peritonitis, ur at any time vrlien tlie ut«raB contains decoiD- 
posio^ innttrr, tho TTiffinn must bo tlioKinghly nnd frequently trnFlird 
ont, 90toie deodorixing tuid nntiiicptii; KnbelAnM' hving mixed with 
wntor. Mnnj obstetriciana in pn^pern] fever and otlier cocditioos 
wub out ID this way tho cnvitr of llto womb ititc]f. 

Ill ompTPma, aft«r the cheel is ojiencd spontaneonBlj* of artiBciallv, 
the putrefaction of the cnntninrd pus rnaitt bo provt^ntM by irnnhing 
oat the okvit}- with antiseptic substanoes. A eolntion of qniiune, 
eight to ten gmitiK to the onni'c, it vorj- nwnful for thin pnrpoM>. Anti- 
septic solutions in sloufrbint^ of the throat, as in erarlet fever or diph. 
tlieria,and in (tnlivation and nicrrntion of tbc montli, will rcrooTC tlio 
foul odoBr and tend to arrest pntrvfa^tion. 

A Btronp: (olatton of cfalonnatod soda ban boon highly rcnommvRded 
in diphtberia. 

The deodorising' and antiseptic substAncctt c-bicAy in use, bniitdcs 
Uto BMinbers of this group, are iodine, pemanganBto of pntanb, and 
carbolic neid. Solntions of pormnn^nato of pnlfucb, unless nnnooex- 
atrily Mroupr, arc bland and unirritating ; while the chlorine and 
cftrbolio oei^ •ololions are BtimQiatiiiEr. and ereo irritating. Carbolic 
ncid in Bome rospecta is inferior to the other members of this fn'oap, 
H ainee it Meraa to lack power to destroy olTensivo g«MC. 



I 



IODINE. 



I 



i 



loiUKK jMKBPtiieB powerful ehomienl nffinitit*, nud cotabineti eiiorgeti- 
cally with many organic and iuorf(anic substances. It is volatile, and 
rcatlUy {venetrates the animal Ivxluros. 

It IB appliod to tho skin for a variety of pnrposcs. A stront; soln- 
taoD, an tbe liniment, is frvquvntly niicd na a nibofaciont and cotint«r. 
irritant, prodacing at first a senitation of beat and bnmiag, wbioli 
nay invreaan to an nnendarabla extent. The inRamination it cxcilna 
mpantes the cnticlo to a greater or leas extent from ibe dermis, io 
Blight it may bo that in a few dnyn nurc flrsi^iunnntion reimltti ; ))ut 
if tito liniment is Btmng it rapidly proiluces even a blister containing 
MMimi with mnvh ftbrin, leaving eometimcs a poraianent itcar — a miii- 
adventDre which shonld Iwcarcfnlly aroidcd. 

1'he i^Win can generally bear two lightly •painted coats of the 
Pliarmacopaia liniment, nnl'Sx a prerious npplieation haa rmdcrcd 
Uie ekiB thin and delicate* wlien odo coat, ligbtiy applied, is all tbal 



144 



lootn. 



van be endurvd. If, as someiimea liappeas, the apjilication j^^^| 
mooh paint tho iodiiw thould bo waalied ofF n-itb spirits of wmt, 
gin, w whiflky, esa de Colo)^, or, best of nU, mitli n solnlion of 
iodide of potnMinni, and tho pain subdnod by tho application of a 
ponltioo. On and ivronnd the paint«d spot iodiiie liniment will ofUm 
excite a crop of itching papoke which oft«a nppeou- aa late as the 
third or fourth day after the application. 

The liniment applied to tlio obnit aa a oonntvr-irritast in cltrontu 
fdonrii^ Im osed to promote tlie absorption of tho fluid ncounialated 
in the plcnm. Pa!ut«d under the clavlciUs in the chronic fonns of 
l^tiiiaia, it is of grvat servic« to allay harassing uoof^h, and to chock 
MOKtIoD from tho bronchial tubes and oaritira of the Inni^. Painted 
over the front and back of tho chest it ofton affords rdiof in chronic 
bronchial catarrh by eaaiDK ilie cough and lesMining expectoration. 
It may also be paintod on any ;Mirl of the chMt afTec-ted with plooro- 
dynio pains, although a nia&tnrd ponltioo is preferable, as it can Iw re- 
applied should tho pain return. The iodine, howeror, may nwcood 
vheio the mnatard fails. Iodine ix painted around joints affected 
with chronic rhennutiion or chronic fconi, or with chronic sjnoritis. 
like Uiftters, it eases tho pain, and often rxfmoves the Bnid distending 
tie c»rity of the joint ; like blistei*, too, it often causes, for a few 
daya, increased distension of the joint, ihe good effeolit not becoming 
apparent till Inter. Thia increase of the sirelling may be regimlud 
■s an indic«tion of the socooss of the application. The liniment is 
useful when painted on the nkin oror a bronchocele. It should bo 
applied — ^though it can seldom be homo oflener Umui once a week — 
as often as Ihe state of the nkin will permit, till the tumour dia. 
ajtpeara. The liniment or tincture is rooommendod as an i^lioation 
to lupus, painted not only on the edges of tho sore^ bat also over tlio 
tisaaee around it. It is said to arrest the spreading of tJie diemsp. 
la tbe form of ointraxmt its a}i]>licittioiui are manifold. It is of tbo 
greatest benefit in chilblains, if well rabl^cd over the affected part 
beforo (he skin is broken. Tbe tinotnre lightly painted oror Um^ 
part is often used for chilblains, but the ointment is far more effla| 
oioos, cnring unbroken chilblains in ono or two days. In this han^| 
inj; affection I kuotf uolliing so effective. The intolemble itching a| 
chilbbins is often very dilBonlt to relievo. Uot water often affords 
tefupoiafy relief. I liave heard patients say that an infusion of 
calory, used as hot as tan bo home, is highly efficaoioos, and that the 
«noaoy is not simply due to the hot water, as tho ooloty inliBsioB 
affords far mere enduring relief than simple hot water. Benaoiii, 
Iodine disenWod in ammonia (colourless tincture of iodine and lini' 
Divnt of ammonia) are each useful in ohitblaina. 

Iodine ointment is often useful na mooring boum of the non- 



lODIKB. 



1« 



I 



inflammatonr puius of the Gh«>t ; but tittte, not htiiog alwRjs of tlw 
same niitnra, (HKonminntion mnst be exercised. When the pain ia 
sittuitod ia tli« muBcliM (ntj'aljfui), uiil th«w nr« tender on pressure, 
while tbe kkin nmy be pinchod witbout pain, tltu> ointment i» indi- 
cated. But if tbo t«Dd«rneas is sitnated in the akin (pleorodjuia), 
boltadonna is to be preferred. I btdivve Dr. Hare first pointed ont 
tub dixiinction, and it is one which hotda true, though not williont 
except ions. 

The oiutmeat, tincture and liniment of iodine are ated for tlie 
sanif [>urp<nK«; bnt it must be reeoltectod that the ointment and 
tinctnre art' much mildfrr prvpamtionf, and will even after sereni 
applioatiobti prodnco bnt a small amoont of dcaqoaowtion. When » 
strong irritant actLon is needed, the liaimont mast be employed ; and 
a medium effect can be produced by snitablif diluting tbo linimout 
with spirit. 

The tincture or the ointment is often applied over iudnnted 
■wollen glands, or parte thickooed bj intlunimfttion, with the ia- 
t«ntion of removintf thu diseased produoU; but whon painted over 
BOTofuloiiK ginnils, or glands subocntely inflamvd, care must bo taken, 
lest tbe applicatiouM increase the inftainmatton and fiivonr Kuppuru- 
tion. Ii>dino mixed with Yig\\t oil of wood tar in the proportion of 
two draubms of iodine to un ounce of oil ot wood tar, has been 
reuoDunended by Mr, Coater, as an efficient application in tinea toa< 
snrsna. It nsuall; prodaoes no pain, and without doubt pTcvonts 
the extension of this tronblcBonui disease 

In many cases where tbe disease involves a largu part or tbe 
whole of the hnu), this application may be painted over the entire 
BCOlp. Occasionally, however, the skin is so delicate that ibis ex- 
tansivo npplicfttion cannot bo bomc, and then it sboald bo applied 
only to a small surface and painted on a froeli part daily. In some 
case* it gives so much pain that it cannot be at all toli.T«ted. 
Coater'a paint, as mi(;ht bu expected, is far morv dTednal in the 
oircnawcribod than in tbe diffuse form. 

The lininieat, oiutment, or tinoture, will remove herpes oircinatna. 
Udo application of the liniment is enongh, but tbe oiotment or tinc- 
ture must be applied once or twice daily. 

It ia siated that painting the aRectcd and circumjacent skin with 
a solution of iodini", will prevent tlif i-pitAd of ery&ipelwi. 

Mr. Jordan speaks highly of tho applJcjitiiiu cf the liniment in 
the neighbourhood of local iuSatuniatiou ; applied so ns to prodnea 
veaication aronnd a Imbo, an abscess, or a carbuncle, it considerably 
ndacrs inflanimatioii. 

In hydrocele, iodine in solution, generally tbo linclnre, in perhaps 
tlie beet flnid to inject into the serous cavity aurrauDdiuf; the testicle. 

L 



146 



icoaaL 



The Hrooa fluid ut fintt drawn olf, then tbo iodine ta injeotod into the 
carity, wbioh, exciting iLdhosive inlUmmation, tho contifcaons Bur- 
fkce of Uio KIM) unilut, and tltu [orUinr olTuniun of Mrnui is rendered 
impoisible. 

Iodine Holution is injeoMl into jointu nffMtcd with white nwelltng, 
into tho cavity of th« pleura in onpyioma, into ovariftn tumoara 
after tapping, and into larf^ abscesace after tlicir crncnation. Ton 
ooxtote of tho tincture, nnd cvna 'more, mnj- be injected into an 
owian aar. The roHultji of tbu oiui<.ti iknx treulud are moat satis. 
hctorjr. lite injection of white swellings is said to preduoe no ill 
sjrmptomii, and unleaa there is caries or neraoHiii of tho bones, or 
swelling of tbo snrroonding ports, this treatment is geDemtlj 
(arm) mill I'. 

In ohroDic plenri^, after Uie ndo Iion boon er&cuat«(I, iodin« 
injoctionH nmove tho ^'reat fwlor oftou pnmont from tbe dcoonu 
position of pas in tbo plcaral mo, and at the same tiiuo diuiutsh 
tlui aacrotion from it« walls. Tlie injection rauitt at first bo weak, 
say foar or five grains of iodine and iodide of potosattun to a pint 
of watpr, but wlion the slrurtures have becooio aocnstoBwcl to it. 
a stronger solution mnj bo ompLoyed. No doubt tliis treatment is 
often Knc«<iuful, alill it must be earned out with the greatest 
caution, otborwiso inflantmatiun, witb bigb foTor, may set in, and 
proru fatal. 

Mildvr injections, containing permanganate of potash, or a anall 
quantity of creosote, or quinia, are generally atloqnate to destroy the 
ftetor, in which case the more powcrfal ogenta aru of oonrac not to 
be naed. Since the wasting, the loss of appetite, and doprossion ia 
caws like thcso ia mainly traceable to tliu abgior]>tion of poisooouB 
gnaea and putrid fluids, it ia of the highest importauoe to keep tlM 
sac free from lh«m. 

loditio Milutionii, injected into tbe oovitiea of large alwooam, their 
coalmls having bocn ilischargod, often prove very sorviooable. Tho 
tJMitnru iiduU may be freely Tised; the cavity of the absoeas tthonid 
Bubsequoutly be kept clean and aweol by froqtient washings irilh ■ 
weak solution of pennanganate of potash, lliao and Inmbw 
abaooB*, ton, may be treated in this wny- 

Thc hypodermic injection of linotnre of iodine^ in fire to fiftoon 
or more minima, is now much used for bbo euro of broachooelo. 
Iodine is also useful in hyportrophied tonsils and glandular tumonta. 
The tincture mutil be injected into the glandular enlargement, and 
not into the connective tissue, or ulceration will ensue, Tho in- 
ioctaoB ahould be repeated once or twiuo a we<^ 

The tiBcture of ioiUne may often be used as an iahalatkm, with 
signal bsnaflt in the four following instances: — 




tomst. 



147 



ft 



I 1. In tbc chronic fonns of pfatliisia (fibroid laiig)i wli^n Uie expec- 
'ian.tioa is abundiuit, and tba cougU troablcnoinu. An inlinlatioa 
iiM<l night uul moraing, will gADcmllj' leewn the expectoralion, and 
nllaj tho 0011^ 

i. Childron. six to tcu yearaof a;^, aflor measles, or independent If 
of it, an cxpci«urcf to caKl. am nciznd vritU lioiirMiitvst, n hoarno hollow 
coagh, and eome vbeoxin;; al tlio chest. This aQoirtion involving; tiw 
hirjnx, tnuihoa, and tarffur bronchial tnbtai, often proves vorjr obstiiiatei 
is apt ta retnrn, imd to persist a considerable time. 

3. Id bodu; cpidoaica of diphtheria, Dr. Wariog-Cnrran recom- 
nends the following mixture :— 4 Rrains of iodine, i grains of Iodide 
of pntoflHiRin, 4 dmchnu of alcohol, and 4 OBUoec of watrr. A tea- 
epoonful of this should 1m added to boilinf* vrator, kept bot by a spirit 
lamp, and the titvniii inluilcd. Ah ihu jiutiunt Ivccomoi accustomed 
to Hut iodine, the qnantily of the solution may be iDcroased till half 
%a onnce of it is UKvd at each inbalatinn. It xhoald bo rvpiMit«d 
many times a dajr. and each inhahtlion continued from eight to twelvo 
BiiDDtee. 

4. In itvhing of the nose or of the inner eanthnii of odd or both 
eyee, aneexin^;, ranning at the none of u wal^ry flaid> weeping of the 
VJKB, and MTero frontal headaohe. Patienttt of varioTia a^'s ariA 
greatlj tronbled. often for many years, with daily attacks, lasting it 
may bo seroml botirti. Iodine inhalation uflvn nmiovt-'H thi* nffoction 
Aionoe, and when it succeeds partially, it almost alwaya lessens tiw 
bDadftoho and tho disohafga from tha nose. Itx cITeot is movt marluxE 
on Ibe itching. {Se« Araenio.) 

I generally adojit the following simple, handy, cleanly, and effectnal 
plan of inhalation : — llcnt woll a jng capable of holding nbont two 
pintfl, by rinsing with boiling water ; then partially fill with boiling 
water, Jnto whioh pour twenty to tJiirty drops of tho tinctnro of 
JodiDB ; Uicn dirnot thi' patient to put his face over tho month of tho 
jng, and to breathe the iodised steam ; covering both the jng and the 
pativnt's head with n towel to prevent the eaoapo of tho st«am, 
This inhalation abould be used uight and momiag, for five minat««, 
a little loDgar. Occasionally an exooKs of iodine will t<.-n]porarily 
dnoe a aonsntion of soreness in the chast and throat, somctimoa 
ith radoess of the oonjanctiva, ninning from the noee, and pain in 

head. 
Iodine iiilialation is somotimna employed in clironic bronchitis ; bat 
ithont much advautuge. 

The tincture is nsofnl to remove tartar from tho tooth : and to 
staiiuilat« the gums when they begin to recede, leaving the teeth 
exposed, and more liable to dcoay. It should bo painted over tho 
jnuna close to the teeth. 
r t 2 



148 



lODIDB or POTAfBIUM. 



An iodtno gftrgl«, in&do with two or four dmchmN of tlio tincture 
to eight otuicofi of water, haa boon reoommeuded to allay luorcarJAl 
calirntton ; nnd tho tinclnro of iodinn in iipplivd to xorvti of Urn throttl, 
ejrphilitic and niniple. 

lodino^ in nndim (innatity. iiritutcii nnd oxuitoti iiiHiunmation in the 
delicate stmctnrce of the stoninclt, inducing pain at the opigastriaiBf 
Tomitin^, diarrhoMh ■oini'liiuL'H mui'h <:ntla])r>i?, and iiren d«alh. It 
should be gir^n aoon after a moal, when the mucons laombrane IB 
protooted by thu food. 

When iodine nnchea the stomitoh or inteBtineft, and ceMtinly wbeo 
it «nton tlio blood, tlioorj would suggest tliat thi» drag bocomm con- 
verted cither into ui iodide of potftsaiom, or, mora probably, of 
sodium, and tlienoefortb. in it* onnxn- through tho body, it wonld 
bobavc as an iodid*. Pntctioally, there ia maoh lo confinn this view. 
Mt tlic notion of iodine on tho distant i>rgan« of the body ia very 
generally admitlod to bo identical witli that of the iodides ; y«t mhuo 
imw-'tical anllioritiea state, that in rhronic rlninmatic arthritin, tha 
tincture of iodine in ncrvivcable when the iodide of potassium bila, 
altliough it is difllcalt lo nndemland how thix ahould bo. Somn 
bocomcs oODTcrlcd into an nibii minute. 

Iodine may bo usod iw n iho'lorizer and diiiinfoctimt by simfdy 
suspending over the patient's head a lidteaa obip-box, or aauoiir, con- 
taining a few grain*. 

Dr. Ander(on rcocimmewU iodine in mnhurial fever. H« hwi 
Ircftted "upwards of 800 miics with atmo«t invariable souoeM." 
He giTM from twelve to fifteen niiaims of the ooiupound tincture. 



A KEW INTRODUCTOBT REMARKS RKGABDIXG THE 
BKLATIVE EFFECTS OK POTASSIUM AND SODIUM 
SALTS. 

Ix proacribing a medicine it ia important to recolloot that an 
eleininit on combining with another element, doea not loan ita ohanM- 
toristio action, and tlwt the aolioii of a Ntlt is the itnm of the aotJoa 
of ile ootnponeDt parts. For inatanoo, in bromide of pottwaium wo 
atill hare tlte action both of bmmino and potaMinm, and tJieoe nib> 
KlanocB on combining do not loae tlieir individual projierttoa, nay, 
ihcimojMnile aetivitiesare Init lilth)dimiui&li<'d, f o (hat all potaMiuni 
anlui appear to be equally poittoBona to the animal body. Of mane 
if the «)t baa an arid or alkaline icAotion, it will a<^t in virtue of ita 
acidity or alkalinity; hut from nuwuruaa exporimonta all »«utral 
watt* of potash np^ioar to bu cqtudly poiaonoas. 
Wv ofton prt-acribo romodiea for their ncid nulielu only. Thia ia 



fOIlSSIOM USD SODtCll SALTS. 



149 



^^ with iodides and bromides. Iodides act certainly in most 

^BiMUM io virtae simply of Uiti iodinu or bromide in virtun of the 

^■braniine. Hithn-to tho prnciico has Inrgoly pi-ovoUed of proscribing 

■^tasdnm compounds of iodiuo and brominu in preforenoe to Cbo 

Rodiam <ir tuiiDinninm salts, bat tbis practiuo onght certtiinly to 1)0 

avoided, for potftssium Balls nre £nr more poieononit tboa tlie 

Modiam or iLmmoninm ealts, iritbout being in luanj cases mors 

tbarapoalicallj active- It ih obvious wc onght tn nvoid Ibis cnncccK- 

IMTj dapremion arising from the iu» of potuninm salts in preferenua 
of sodium aiis. 
I will now draw ntt^nlioD to tho differenoM ohieflj between sodiim 
and potawiam Kalts ; diffRmno(« in dagreo^ bnt id some purtiunlsn 
likewise in kind. 

■ PotassiDm salts nro highly poieonons to till the Miimal tissnes, 
■tispoiiding th« fnnctionol nclivity of tbu nervous and mnscalar 
stra^turcs, and probably of all tbu tissues of the body. On tho other 
hand, tho corresponding nodinm Katts Are almost atoxic, even whon 
administered in much larger doBi>fi than tbo potassinm enlts. 

This dtB«rcncu botwuon potsfsinm and sodiara compounds is well 
exoropliliod in oxperiments on the vi^iitricle of the frog's hoart. 
Potassium saltn lunrkctdly alTcct boUi nervons and mneculnr fanctions. 
Small doses affeet the spont&neoiui contractions, at first grcatJy r«- 
iluvtng thoir frcquoucy, and thoa arrootiDg tbom, whilst ounaiderable 
contractility still iieraista, which may be made evident by stimulating 
tfbt ventriclo by an induction sliock. A sliglilly incroued doee of the 
potassinm nails soon suspends contmctility likewixo ; sodium salts:, on 
tho contrary, affect spoataneoiui action veiy littl*. so that iw long as 
^■eontractility lasts spoutanooiis action continnos. Sodium Baits, mora- 
^OTsr. moat bo given in doses fourteen to fifteen times laif^er than the 
potaasiBm salta in order to suspend muscular contructility. 

Whilst potassium salts largely inoroaso the latent period in an 
indooed muscular contraction, sodium salts prodnoo very little effect. 
H Potoasinra salts greatly au^ent tho duration of tbo period of 
diminiahed excitability. Sodinm salts very slightly extend this period. 
When the ventricle is strongly faradiEod, it is thrown into a tetania 
atat«. Potasnum salts in small doses prevent this tetanus *, wbilst 
^^ndinm salts, even in much larger doses, bat alif^tly lesson it. 
^k Faradicalion arrrats the sponlancotts conti-aotiona in a ventricle 
^noieoned with only a small quantity of a potassium salt; but, on the 
^Poontiary, Puradisation applied to a ventricle, even when arrested by 
•odium sail, induces the return of oontractions, ouu contrnotion being 
piled on the tO]> of another, and tbna a considerable coDtractioa of tbo 
Tontriclc is produced, and ia sustained as in tetanus. 

Thna we aeo that potassium, even when combined and {ormiog 



L 



150 



rOTABSnm axi> sotiiiiii sujts. 



neatnl leelte, etitl acta bb a powerfnl poison, whilst so -weak is tbo 
action of sodittm that it ctkti bardly 1)o caUed a poison. Frofn 
theaa iaeiB it is obvious thai when we eook to profit bj tho action of 
tli« acid ntdiolo of iodino or bromin<!, we shoatd giro tbo pn-pnrntion 
of Hodiom in praferaooe to that of pot&sBium. So far I kave based 
tliis conclusion on phyaJoIogicul oxpcfiment on uiitnals, but clinical 
vxpvrience ban long taught tlio eaine 1««od ; indeed, potawinm nJta 
art) far mom powcrfallT deprvssing, whilst not more tJienpoiiticAUj 
acli\'o thuu tliu sodium iwJtti. ThcM consldemtions bare led, Utt«rl]r, 
to the introdnctioD of hydriodic and hjdrobromic acids, and of 
iodofonn in place of iodidvs and bromides. These proparaUoas ki9 
stall on Ibeii- trial, in respect to their relative rnlne oompkied witli 
bromidoH Mid iodidett. 

'Xlic poisonoiu action of potHMtinm, Hodium, ammonium, and some 
other mlt*, dopendji mainly on tb« peroeotagv doee, not on tbo 
total amount conveyed to the heart. Id expenmenta on tho detMhed 
frojc'a heart, when snllicient of tbe salt is added to tbe droalating 
blood to cMiao urrmt of ooatractility, this annulled [iro|>erty can be 
reetored by diluting the blood witli an equal quantity of saline 
solnlion, so that the v«ntriole rw-eircs the name quantity of llw aUli 
but in a more dilntcd form. 

Theec facte eliioidat« the meaning of tbo experiment of injecting 
a lai^go dose into the jugular vein, so tliat the ttalt reaehcK tli« 
twsrt in a oonocntrated oondition, and arronts its action, whilst the 
saiue doeo injected at a distance from the h««rt, so that it beoenMa 
frMtly diluted with blood, does not depress that organ, or at least in a 
very siBsll dogroo. 

In poisoning by such sal U it is ovidont thattho treatment ahoald 
eonsisl of free drinking to dilnlo the blood, and s1h> to prnmots 
elimination by the kidneys and skin. Bleeding, too, sliunld be of soma 
serrico. 

Tbeso remarks merely mean that after absorption, all potaab wlta 
appmr to )w (Xtnally or nearly equally poisonous to the nemnui uul 
muM-nlar lissHos, afTcctini,' lirst tbo bmin and eentnil nerrons sytblllla 
next ikv mrvi.'M, and l&Ally the muscles. But clinical experieiMW 
abundantly uhowa tliat some potash compounds arv far raoiv karm- 
ful than otfaen. The most injnriond are alkaline in reaction and 
pradnce a d«|ireHsing effect through tbo stomach, for at fint alkaUas 
berMW the aooretJon of gastric juice, but if loo toni,> persisted in 
thay dbonlor tlw mnoous membrane, and so diminish ita digMtiTV 
powers. In many invastigations witli potasainm salts the msulu 
have boea tindotibtMlly due entirely to the potassium, tbo add radicle 
not jilaying any part in tlic resnlta ; and Lbis vtatoment liolda jiarti* 
Ottlarly witli bromide of potoMinm. 



I 
I 



I 



I 
I 



tODI»E or POTIUIPU. lol 



lODlDK OF POTASSICM. lODIDR OF SODIUM, 
AND lODroE OP AMMONIUM. 

lODtMt of potoannm being an cxtrcmelf solnbld salt, endowed 
vritJi ft vtiTjr hij^h ilifTntion- power, findii roodj eotmncfi into the 
blnod, and apeedj exit from it wiUi the secrettona of the body. 

As lui nct«mal ftpplioation, it formerly cnjojcd more favour tlinn 
U mocorded to it now. A« on ointmc-nt to tUo akin over onlnrgcd 
l*1aDdB. or pnrts tUickniMtd with inflamnijitory products, in conjunc- 
tion with the inlernal nso of iodide of potasainn), it biubniN tlie 
resolution nf obstinate node*, and i» eKpociiJly nsoftil nhon the 
internal nae of tbia salt diengrcos, causing naiuttt, diurrlMMv, or p*nt 
proKtmtion. The ointmntt ix Hoinctimm niied for the itch ; and tbe 
oiutment of this salt, or of iodine, La often nsod in broncliooele. 

Accmrding to most authoriUes, tbu iodidu, probably ftftpr itx 
nbsoiption into the blood, produces decided rtian^Kw in tbo mucons 
membmno of thu raoatli, oauxing rodnosH and inji^t-'tion of the lin- 
ing of tbe cheek, the thrtat, soft palate> and of the tongne, and $m 
incroMed growth ftod ocpamtkii of tlio opiUielfnm covering theiio 
p&rts, and an angmented flow of saliva. These phenomena, bow* 
ever, are certainly often absent nftc^r largo doMS of tlie medicine, 
nnd even in severe iodism. 

A large does irritates the stamnch, and diftorders digestion. Some 
are far more prone than others to be thus a&ectod ; so prone, that 
even tninuto mndiciniU doses sometimes tnitatc the stomoeb. 

LiVe Ihti chloride of aodinra and oklortde of ammomum, this salt 
incnasoa th« production of mncas from the stontach and intontines, 
as wdl as from the mncouK membrane of other ports of the body ; 
bnt when each n rceult is desired, we resort to the chloride of am- 
moniiiin in preference to this salt. 

It* great diffusion- power enables it to pass with great rapidity 
from the stomacli into the blood, and it very speedily appears in tJio 
urine, ta tJmt only a small proportion posses into tho intestinus. It 
pnrgojt only when taken in very large dosse, bnt tt is never emploj'ed 
for this purpose. 

Some nuintnin that when iodide of potnsstnm comes in contact 
with the chloride of radium, cither in the stomachorblood, it changes 
its base, becoming iodide of sodium. At present we know bnt littlu 
what physical or chemicnl cbongca it prodnoes in the blood, or in the 
organs to which it is carried. 

If it* administration is oontinned for n long jwriod, or if the 
patient manifests great sntccptibility to its action, we produce a con- 
dition termed iodism. 



la 



lOBIH or rOTAilglUII. 



Iktaoy pcreous can take tliis dru)^ iu v«ry large qnantiliea for an 
almost indefinite lime, witlioiit tbo indaotion of iudixm, whik verj 
Btnall dosea, evva of a ^raJn or part of a Krain, prodnoo it in others. 

Tlie limiiL-it most frt^ijncntly and vaaub wri'rclj' influunoed t>jr Uiis 
dmg.are liie nincoDs covering; of iLe eves and lining of tiie.DoMi 
frontal einui>, and mouUi, witli the iikin of tlie face. Somo alight 
rtmning at the nose is lirst noticed, with occasional Boeeiing, and a 
little frontal lieadaclie; thc»e KjmiptomH bi«omin^ ninro marked 
when tlie conjonctiva is injected, and the tears How abundaatljr. 
Tlie looie tiiutueH nbont the orhit beconiv awollen, reddonvd, and 
cedomatoDB, and oocaeionally a pecniiar rash appeara on the skin of 
tho faoe^at fint noticed around tlie ejuf, after which it nttaeka the 
Doae and ita neighbouring pnrt«,and then the chin. The parts in iho 
order bore slated arv snvvralljr motb Hverelj affeot4)d. The noso is 
eometioiea reddened, espocinllv at the tip, and is rather swollen. The 
rnaJi dooa not olwaja pretient tlio .■miae appeanuoc. It ih often verj 
maok like acne, ani] is atwafs hard, ahottjr, and indurated, bot th« 
papules may bo broad and large, and ooven-d with vrbnt looks like a 
half>der eloped reeicJo or pnstale. The chiuigcs in the uoulh have 
nlrefl^tf hmn mentioned, when speaking of the influenoo of tliia 
medicine on that part. \Vitb some persons the Btomach is at the samo 
time denuigcd. altliough in the autJior's ex]tBrienoo this organ often 
woapes when tlio face is alfecte<d ; on the otJier hand, tho slonin^'h 
•DmetimcH nnfToni when llie uose and eyca are nnaSeoted. When ihe 
■tomach is singled ont by the iodide, it induces nansea, an<l a eeiiMi- 
tioD of kinking at the epignntriuni, with low of appetite, and some* 
timea watery diarrhtra. A grain or eren less may thus aSect the 
Rtomncb. 

If the drag is discontinned on the oocurrenoe of iodism, Om 
symptoms just described spredily disappear; said the rash on the 
face, the running at the eyes, Ac, will graatty deolino in the coorae of 
twcnty-fonr to forty-eight hours. 

Iodide* aometiiiiea, as 1 ahall show preMmtly, caose diuKois. lo 
•omo peiaoua iodide* prodooo a p«t«cbinl ra«lh affecting almosi always 
the leg ezdnaively, rarely extending above the knecsaud mrcr still to 
the trank or upper extremities. It may. at lirst, take several days to 
prodoL-e this raali, bnt when the apoU liave disappeared, a stnglo dose 
of fire grains may, in tiiroo boars, soflice to reprodacc it SomnttRirs 
on penisting with the tuedioine no frosli rnsli appears, and the old 
Bpota dio away ; wliilo in other casus the rash endures h long us tlw 
medioino is continoed. This rash may be the only apparent elfeii of 
the iiMlide, bul it is generally aooompanird in a variable dogreo by a 
few or many of the symptoms of iediun. The salta of iodine differ 
with iwpoct to the produdioti of this taah ; ibua in many mms the 



I0I>I1>B or KITASHIlll. 



Ii9 



ammoniaiD salt is moBt itpt to indnoo it, miiI the swlitim Kbit lliu 
IcHt liabUi : in otlicr aoMm, where the ammonium xnd poiaasium salts 
produL's » large crop of pctochias, the Kodiuin siJt is inoperative. 
Soiat! iN.i«onit are equatlj affected hy each of these Uircv prvparatioiu. 
In one case, while the ammoniam and polaannm aalts produced 
muneron* prtcchiw, the 6odium salt failed to do ao, hut cxci(«d on thu 
arms sume erjtbema marginatuin. Tho potuchiat ntsh is often pra- 
oed«d by a seDsation ei hoat, aocompanivd bv aonui tendome**. 
Thwo fact< aeom to dicprove the araMtloD that nithcr iu the intestines 
or in tfau blood, all iodidw nltimat«l7 bocoms iodide of Kodinm. A 
pativnt somo joara after suffering from a whito log, took iodide 
of potasnnm on tbr<« separata occasions ; each tiniu an abandant 
crop of petochUo appeared below tlte kuee of tho damaged Itrg, wlul»l 
Dona appeared on the other log. 

lodido of potassiuni sometimes piodneea distnwing depression ,of 
mind and bodj, rendering tho pativnt irntable, dojeot<!d, listless, 
wretched, and unablo to take moderato exercise vritfaoat fatjgae. and 
perhaps witlt a tendency to fainting. Tho appetite is generally very 
bed. Those Bymptams mny urine from a very small done, and muy 
occur without coryxa or irritation of the Ht^imoch — a fact important 
to bear in mind, othorwivo, Iho caoso of the depreiwion Iioing over- 
looked, the medicine may be persisted in. On discontinuing the 
drug, tboso distrouing symptoms disappear in one or two days. It. 
now and then exceptionally happenis that the Kymptoms just deecribud 
sometimos cease in a few days, oven ihougli tho pati«nt gocK on 
taking the medioine. 

When the potassium salt is not toleiated, the ammonium or Mdinm 
salt can sometimes bv homo. Thn$ iodide of potassium in ten-grmn 
dosest tbrioe doily, produced so much headache, eneesing, and running 
at the nose, tliat it could not be oontinnedt whilst the same dose of 
io<Udeof sodiom was I'ssily bomo, causing no Iieatlacho, and only a 
littlo running at tho nose. 

A full dose of oarbouatti of ammonia or spirits of ammonia given 
with tho iodid« of potassium will, it is said, obrinto tbosu symptoms 
offedism; but though I buvu nuuiy times pnt this recommendation 
to the teNt> I hare scon no decided naulta, although perhaps the 
ammonia did oocasioually somewhat contml the iodiitm. 

T«n grainsof iodide of potassium token at bodtimv often cuts short 
an acute cold in the head, especially at the onset. It is much lew 
elBcaeious if the cold attacks tho lungs also, an<l in influenxa it 
Appuara to bo uveless. In ten-grain donus ncvenJ limes a day it is 
said to onre that troublesome and obstinate affection, violent jiar- 
oxysmal HMwiiug (sec Araenio). It is Ukcwino useful in chronic oolds 
in the head in small hourly doMs, as a tcaspoonfnl of a mixture con- 



t 



l£t 



lODIDB OF POTASSnjH. 



Uintag fiTO graiiui to {onr otinccs of «-ator. TodMc of potMsinm ifl 
verj iDtofiil in vhmnic bronchitit, ani) tany bo profitably girvn with 
chloride of ammonium. 

Tbo iodidu in fm^ilnjred in n grunt vKiiotf of duwaMS. It m Iiuxelj 
«mploj'od in sj-phili^ bat in not eqiwlly efficacious in all its fonaa, 
being more luefnl in tiecondarj »nd tertiary syphiliB, eBpocially in the 
tertiAry form, whotw mercaiy nt&j do hnmu 1'ho iodido stiouM be 
ein|tloycd when tlic health ia bro1c«n, when mercurj hita bven 1«kej> 
willioDt good rosnlts, or vrlicR llio hones aro dJsgasod. [t is l-oq- 
^cnonsly beDefli^inl vihna tlio dincAte fixM on the periosteam of tS^M 
bofuis or Bbrons etrnctaro of th? softer org&na and fonaa nodes. nH 
ftotion on Ihia form of thu (liMCOMi in atmoat magical ; it »oon subdosi 
the pain, and tho nodos, if not of ]oag standing, qnickty disnppMT. 
In the tnntment of taberonhir nyphilitio akin eruptiouH, Dr. Neligan 
invfuTK it to a unit of laercDiy. The todido of potosdnm ie of very 
^Toalaervioo in syphilia of de«p-ae»t«d »nd important organs. It ha>B 
bnin comniinulod in nyphilitic iritis; bnt in tkii; c»sa most anthorittM 
prefer nutrciir^'. The secondMy syphilis of ohildreu is beat treated 
with mcrcnry ; y«t the following somewhat raw form of qrphllb 
gives wiij l>Bsl to iodine. In ohitdrvti a few months or yeara old, & 
syphilitic thickening of Iho porioatotim is nomotiinM obscrrnl, niinally 
attacking the heads of aereral of the long bonea, «nd BoraetimeM alao 
the ahafl«. The thickening is first fcH aronnd the hoDMi bnt m ib* 
diMwe sdv«uiccfl the ueigbbonring auft tisanes beconw infiltmted vrith 
a firm cxndutioo, which may increase to snch a dogroo tluit the im- 
plicatml part of the Umb boeomeB mnoh swollen, the akin very tents 
uul shining, and ii little reddened. The afFectc*! parte ore very 
[■niufiil. When Ibu <Iii>en«e ia aeiited at the heail of the ImneK, tlie 
oiovoment of the joint is not impaired. If long nnciired, this 
fionditJon learea behind it prrmnuent tbickeuinF; and enlargvroent i 
and BO we sometimes ace ehildren with syphilitic toeth, and hlinil frata 
syphililie iritis, with constdcrnble enlargement of the headx of mtomI 
of the long bones. 

Certain non-Ryphilitic periostml thickenings ytcid likcwiM U> tint 
teinedy. 

The imlide of potaarium has been rcoommcndc<I in raermtrtal sali- 
votinn. I agree with tltose obserrers who belieTe that [odide of 
pulaasiiint often DggruTateH mcmirinl iinliration; and yet tbo iodiife 
wnuetimsa appears to be undoubtedly henetioial. 

Aa the nclion of the iodide on the mercnry in tlw syatmn tkrowit 
much light on this qnoation, wn will now ahortly iliacnas it. The 
BU'rt-ar}' snlta, like thoae of most other motaU, fonn inaolnble con* 
IHiamU with albnminooa snbelanei'w. Theao oompoamls an ^i-ry 
gonorally solsblo in the dhloridefl, broaidM and iodkUa of the 



L 



IODIDE or KITASStrK. 15S 

•lk»]ic■^ bat cRpncinllj in Ui« ioditlcit. Miuij metabs amon^t others 
;ury and ImmI, nro deposited from tho blood in an innolablc! form, 
in tbe aniniiil ntrnclurfK, and iodide of potoMhim, by re^iliBKolriiii; 
eitlior of these two nietAlo, brings ojne or tbv other again into the 
circa lution, and na re-sDbjm:t!( tho Kj'iitcin ta its intlnence. But then 
iodide of potasainm will promote the Mparation of both mercarj* and 
lead by tho arine, and tJinM help to fni: tho rystum from their 
pcniiciouH effects. 

It has boun Kaid that iodide of potiuuinm will dissolve mcronrj 
componnds of albnmcD in tbe body, and bring thorn Imek into tb« 
ctronlatien ; and hun^in we bare tlic explanation of a u'ell*I(iiown 
property of tlila aull, namelj, thnt of prodncii:)^ ttalivation in pcntontt 
who had proTioiisIy tnlcon a con»donib)n qnnntityof inercOT7. A(t«r 
taking morcuiy for some time, if a patient had ihfa become fadivatod, 
it wonid naturally bo anticipated that indide of potassium would still 
further inerease the pQ^ism, and not check it. In ciiher yases it 
might liBppun otherwilH^; for we have seen that tho salt will affect 
the sepanlion of this metal throntth thr urine. In il oqbc, therefore^ 
whorobnt little murcurj has been taken, during only a short time, 
jet Boffioient to produce salivation, the iodide of pcituNHiam, fay qctickly 
separating tbe metal from the ^stem, wonid remove tho mercnrinl 
^nptoms, inclnding tho salivalion. Shimid it ultimately prove that 
the increased climitmtion in dno to tho morcary being bronglit buck 
into the oircolation, and no under tho influence of the kidneyf, and 
that the iodide does not promote the exit of the metal in any olher 
way, then the iodide mtul be umply hnrmfnl in ini?n.'urinl mlivatton. 

It has been «aid1 llmt this salt of itwlf will prodnce snltvalinn, 
an etfmt which ban Ix-en aBcrihed to the action of the iodide oa tbe 
meraiuy in the way just explained; otJiers hold, even where ni> 
nicrcaiy has bcN;n taken, that the iodide of pola>sium iUelf in- 
finaaes the salivary secretion (o a variable amount in different 
persoDs. 

The nuequallcd efficacy of iodide of potass^ium in eliminating lend 
from the sy»t«m through the nrino has led to tliii employment of thin 
drug in lead-poiHoning. Fnrtlier on, when treaties of lead, it will bo 
shown how, by virtne of ita power of eliminating this metal, iodide 
of potaasiam may provo itself nsefal in certain formti of gout. 

It iaof signal aervice id bronohocele, when the enlargement of the 
thyroid glaiid is duo to hypertrophy, not to eynlio formations, or 
to other eansoB. Ita internal employment i» oittn snpptemented by 
painting the swelling with tbe tinetnre or liniment of iodine. Iodide 
of potaasiam is used too in either induration or enlargement of the 
glando. aauf the mamma or testicle, thoogb with less lutvnntago than 
in broncbooelo. 



UHMH OP roTJiDatii:!. 



The iodiOea qnicken the absorption of mHatiaaMtoiiy flBacioD, rocb 
M occuni in plfitnuf ttad in inUnminkUny tUiukoning of organs. Iodide 
of polossinm (tometimes relieve* BcUtica »ud Inmljago, nlthoogh it 
wry oftun fitiU to tiffcct cilher, especially aciatica, evea when Uie 
pain is worse at night. 

Iodid« of potoarium BometimBB beuefiu ckninio rhemnftlisin. 
chronic rhunniAtic; artlirilia, ohranio goal, MpccinllT tbo two former 
affoctions. It alioold, however, nlwaj-B be borne in mind that Uw 
pains of accondanr nygihilii, fnciuentljr rcuombling in all rmpoctH 
thoM of BO-cftlled chronic rbvumatiamt ar» frequently confouiid«'l 
with, Bud included anumg, the manifold alFootions tormod chronic 
rheunuitiNiii. Some of the so-called cawa of rfaenmatiaia relinked hj 
iodide of potaannm are probably caaea of qrphili*. 

The pkiaa which yield to iodide of potaBsium are mainlj thon 
markMl 1^ noctamal inoreiwe of saBerin^, a Nj'm{i|om which DUiy bo 
accepted aa a alroni; indication for tbo employment of this mediciM 
—an indication holding true, whether the paina are referable to 
rheunstim or to some other ttonrce. Syphilitic jiains, it ia well 
known, are geoorally woniu at ni^-hl, and so are tho pains of many 
cases of clirunic rheumatism ; now, tlio ioditio generally beneflto thoM 
rhoumatio cimion. 

Iodide of potosdium is sometimes singularly useful in peptic and 
bronchial asthmu. Fivu grulnii or more, three timca a day, may be 
required. Sovt and tlien its gootl cOect ik not manifoatod for *ome 
tim^ thoBgh pomibly in mch a cauc, largar doaca would bring 
prompter nlief. The late Dr. Uydu Salter, wbilflt a«lmitting iIm 
great efficacy of thia Mdt in some instances, wa« inclined to think 
that in tJie majority of cases it i* uaolcM. My limited csperioiioe 
Imda nto to think it uoro frequently naeful than Dr. Salter was 
willing to admit. 

Iodide of putoaaiiun has sometimes obviated buranneH, presninsbly 
doe to Mypbilii). 

Iodide of potassium occasionally aots as a powerful diuretic in 
Brigbt'a disease. 1 liavo Nncn it rvraoro all tho dropqr hi thoroughly 
water-loggad patients, evory part of the body being OHlonuitoQB, the 
log« iwoUon till tliey oonkl not be bent, the akin shiny from disttui- 
sioD, and tho alxlomeD diileadvd with fluid. The iixlitlu incrvowKt 
tlio wanty nrine from a few ooncee dally to 30, tlien AO, 00, and ISO 
onBoea, till tho dro]>sy dimppvarod, every rcetige of it, in a fortnight. 
While, however, thiw drag iucrauied tke nrinaiy water and reuoved 
the drojwy, it produc^xl vory little effect on the amounl of albumen. 
Of ooBnio, ill pniportion to the increased qiumtity of nrine, the 
relative amount of Bllmnu.'n diminished ; bot, in fact, the albnmiauns 
iirini* is simply Uiure dilnlpJ, and in cxttinating the amount of allnt- 



IODIDE or rorissim. 



157 



mon soparatoil id Uie d&r, vto rnuxt bcnr in mind the amoniit of nrine 
voided. For instaoce, if a patient J» pimjng oaiy ten ntinrL>)i diulj-, 
and on boiling tkv nrine tbo congulatfid albumen occupies iinlf tlia 
tnbe, if then tho nrine is increased to twenty onnnm the coti^alatvil 
ulbnmen will occnpy only n qaArttn-of thci tuho. ftltliouf-h theqaantity 
of albaiDon Boparat«d reniaiu the same. Whnvf tho indld^ proved 
Ml tuefal, I At one time thonght tho putiuut had Hufferetl from 
syphilis of the kidneys, and that tho drag', removing thix diwoFUw, tho 
kidneys recoTerod their lost jiowur nnd cliuiinuted tlie dropsit^itl flaid. 
In •ome of my ciucn, however, thrrc wrnii no reason to cnnclnde that 
t^a patuots wore syphilitic; the diHease, in somn cnm'H, fnllgwing 
aoKrlet f«rer, in otlicnt it npprjtrcd to bo dno to oold. Like other 
dinrGticn, an, for instance, resin of oopaiha, its Action in very uncer- 
tain. In mnny caacK, in most, indood, the iodide failti altogether; hut 
thin nnoortftinly can in part bo explained ; thus a moderate dopio of 
from five to teo jfniins wilt act powerfnily with n curtain immber of 
patients, whilst in others the doso mnxt be very large. In one case I 
did not obtain it« dinrntic action till I gave one Imndrcd ^riiins 
daily, and ovon this dose had to be increased to two hundred daily to 
toaintAin the eflect and eliminnlo nil the dropsy. \ow, in moKt 
patienu, large doses bring on severe iodism and depreottion, so Uiat 
probably the diarotio doso oannot be reached. In my exporicnce, 
iodide of potossion), like digitalis, ceasm to act as a diuretic when 
th(! dropsy dlsappcnn. 

Dr. Balfonr recommends in aneurism, iodide of potawinm from 
five to thirty gmin dose* continood for a considerable time, eveu for 
twelve montlia, conjoined with the recumbent {Mwtnru nnd n re- 
stricted diet; and he namttes several caeo; fltrikinf>Iy confirmatory 
of the efficacy of this mode of treatment. Dr. Chncknrbutty supports 
hi* statement)). 1 too linro seen on sorenil occBsions large doses of 
tbe iodido of potassium afford prompt relief in the severe pain from 
anenrism: the drug presumably acts by lessoning both the size of 
tbe tumour and ita prcMoro on tho ncrvcfi. Id some cases it is 
certain that the tumour grows amaller and teas pnlsatilo. Patients 
sometime* aJMcrt that a slight diacontinaanue of the iodide of only 
36 to 4^ hours, is always followed by an increase in pain, wbtoh 
ceasea on t«tuming to tho remedy. Large dosos are sometimes 
reqaircd. 130 grains or more daily may be necessary to afford 
relief. 

Iodine has boon detected in the blood, saliva, milk, and nrine, ovcai 
in the urine of the sucking child, whnse mother was taking iodide of 
potassium. Its great diffnuon-power renders it probable that it 
miKhL be delected in all the fluiil!> biithini; the tis<iuea or moistening 
the cavities. It appears in a few minnlcsin tho urine, and still more 



1«8 



BKOWBB or F0TA9S1DM. 



i^dlj in Uic inlin. Tfa« npiditj ot its absorption is. of connio, 
iaflnionoed hy th« slata of tho stomaoli nnd Towalnr ajNtoni, the 
abaorption oocarring mont donlv wlion these are replet*. Th« 
■tot«in«ntA oonceriiing tU inflneoce on tbc vnnonM conHtitDcndi of tlio 
urine ant so discrofwot, and tbo observations made on tho snbjoci 
M« to in)]ierfeot, Ihat at prewot our knnwicdgv in this rc«p<Krt muiA 
be oonsidorad nntrastvorthj'. It is rapidly soparated from ttie body, 
and, erim after larRe doses, soon lieconiiis iiidotoctiUD in tbn nrine ; 
indeed, after withholding tbo dmif. ever; tnice of it may vauiiih in 
leas than tweoty-foar lioum. It i* stated on dnnbtfnl groanda, that 
it inaj be detectod in the saliva soma days aft«r it haa ceased to 
appsar in the nrine. 

Some writers hold that iodide of potassium given in laifia doMS 
for long periods may pn>dnoe albnmen in tJivnnne, and erea Bright'a 
diaasiw 

Atkinson finds that iodic^o of potasaiiiiD often caases oxalat«a to 
appear in the nrine. 

It b said (hat in BriyUt's disease iodidos are not eliminated hy (he 
kidnojm; and Dackworth found Iheir appuaranoein the nrina daJajad 
tor an honr or louj^er. 

Pivo ftrains iLroo times a day is genornlty u mfficicnt doM. Son** 
timf*, as in rheumatoid iirtlirilii^ and in syphilis, no l)cnoBt [a 
obtained until mocli l^rffor quantities, or ton, tiftoon. or even twenty 
grains are giren at a dose. 

litrge dosM arrwt tbe rapid sloughing of ccrtein syphilitio sores 
and promoto the healing froocss. Kull doses sometiniM snooeod 
when stoaller oum fail. 

For tbe renioTal of syphilitic nodta from tbe membnuics of tba 
brain, five to (en grains, repeated three times a day, is genvrnliy 
niflicivnt. At (irst tho drug M>motimcH intensifies tbe pain, then tlw 
dtBoaao rapidly docliiica. Ju no ollit^r uSootion doea this ■'M'd^oiiw 
yield nicb Htriking results. 

lodido of iwUssium may be oonvenieady adiBinisteiwl in milk. 



BitOXfinK OF POTASSIVil. S0IHU3I. ASfMOinUM, ATKXi 

LITHIUil. 

TitKHK salts in {tliysioal and i:bemical propertias are clonly allied (a 
the corresjionding iodides ; yvt in their action on (be bodyt tbe 
bromiJos and iotlidcs exhibit considerable dilferenoca. 
The jjurmtveriiif; use ot bromides occasionally prodaees an aoaefom 



DKOHIDB or rOTAfiHIL'U. 159 

nudi, und 6von boils. Vet I)r. Cbolmeloy reporla the cure of some 
obeiinat^t caww of ncoo by moilerata doNCH of bromido of pntusintn. 

Brumido uf potAsaiam, in five pftrts of (jlycerine, ba« provud useful, 
it is said, as a local application to on«o the pain it) bmnan-boids, 
Gssnre of the Teotum, and in painful growths. 

If talcen in modcnte dosM for namo tinto, or in larger doses for a 
tLhortvr liinis bromide of potassium diiuiniNhra tlifl seosibililv of tUu 
soft palato, nrolo, nnd appor portion of tholpbarjnx, tM vTtdoncod by 
tbu abm-Dou of movement in tiuxo porta wben t]i«y are toncbcd. 
ZaipSel finds thai bromide iif poUkminiti affects tbe reflex irritability 
bat not tb« scnHibility of the pbai^nx ; thns, after ita nse, irritntion 
of the throat will not excite deglutition, but tho pain of operations 
is not IwsMined. Ho a>rroo3 with V'oisin, tliitt lliirty ipiiinH may bo 
iamffloient to *fFect tho phurynx, and llwt sonotitnce it may be 
Bsoeanry to repeat ibis dose two or three timcv, u fuvr lioara apart. 
It hu been reoommendod to giro the bromides to reduce tlie exoita> 
bility of the throat preparatory to' a larjngvaaopicnl examination; 
and it is even averred by some writotK that merely broshini; Uie 
pbnrynx and tiaft palate with a solution of the bromide \m mlficiont 
to quell tho irritability and to permit a laryugoscopic esanunalion 
with comfort to the patient. Many observer*, howevur, question 
this ue of bromide, and Dr. Uucketisie oonsiders that ice atuue can 
lower the excitability of tbe pharynx. 

Assuming tliat .tbo bromides poBseaa the property of diminisbiof; 
tho eeasibility or the reflex irritability of (ho pluirynx, it was 
naturally surmised that they noold lesson tbe excitability of the 
laiyox, and thiM proro nsufnl in those diseases acoompanied by 
upannodic contraction of tbe glottJSi as whooping>cmigh and laryn- 
gismus Htridulns. 

It 18 possible to reconcile the diaore|>ant statement* concerning the 
inflaence of this remedy on thaso diseases. Now, as to whoopin);- 
ocMi£^ all observers most admit that soma cases are nltogetlier 
uninBnenccd by this remedy, and it neither lessens the frequency 
nor tbe severity of tbe paroxysnu of coughing. In other csaee. it 
afvpoars to control Inth tbo fnqnoncy and tho severity. Tbo 
bromide, I believe, will only be foond Merricenblo in simple aocom- 
plicntod whooping'Congb. If there is foror, or much catarrh of ibo 
longa, if there is pnonmonia, or tubcronlosia, if tliw child is teething, 
and tlio gnms are swollen, n.-d, nnd poinfol, or if any gaatriu imta. 
tion exists, then till these complications hare been mot by ai^ro- 
priate treatment this remedy hils; but when iho case has been 
rednccd to a simple form, the bromide of potassinm dova certainly 
inflneDce tho diaooae, leasening both tbe froqaency and severity of the 
puoxysiBB. 



160 



DSOgllDfi OF FOTASgim. 



It iM tfanB iaaaA to be of moit HerHoc in the suinmer, or when tho 
weather is goninl niut mild. Liko otJior nunediea for wliooping- 
oongbf the Womides are more offiotcioiiR in kotDe c}ndoniics thtin in 
otbora. 

The«fficAo;of brouide of pota^aium tn l&iTngiiimuH til rid n I as, is 
Babject to oonditions TOry nimiliir to tho«o which limit iu asofnlneaa 
in whuopiug-oouf^h. Anj irrilation, aa tliat from tvt'tlito)jr, miut bo 
romoTod Iwforc iJii; romvdy nppcnni to manifest wij" jvtwpr. 

Aa, howpvfir, in cold HpoD^^ing. ire posaeos a care for larjngJMnitB 
BtridoliiK, ready, prompt, efficiont, wo neod not ofton have reooorae 
to tiui bromide. (Set Cold Bath.) 

Tho bromide* are sometimH naeful in wliooping-wutrh, Mid Inrjm- 
giRmos stridulus wben comt^cated with comiilsions. Uoriug a 
paroxysm of Inxyngismnti iitri<lnlti», or whooping-congh, tbo obstnic* 
tion in the larynx BoniotimeA becomee so nrgcnt aa to induce rmy 
imperfect oKidation o( iki! t>]ood. and to caniu: fwrtial atiphyxia, 
remhin^ in an nttock of convnlsionK. ConTtil»iona, moreov«ri 
are not nncommon in larii-ngismus, independent of luiphyxia, niiac* 
oomptuiicd with an atlMik of cron-ing, the early and leB developed 
atagc of ibcee conmlsive attAcks being manife«(ed in mrpo-pmlal 
oontnctiona, Sijainting, do. The bromtdM will oonlral tlii> ivcnr- 
rmc* of th<!K(> conrnlBionfl, even when the diaeaae itaelf is apjiarsiitljr 
otlMrwiw) nninfinenoed. 

With regard to laryngismus stridnloB, cold sponging is genetaDy 
snlBciont til avert convuUiuns ; but iu autnn wbure, from the vffoebi 
of any irrilalioit, cpl<l njMingiii^ iu inclToctnal, the bromide of potaa- 
gium will, in meet instanun, avert the conToliions, thus obriating 
one of tbe gmv«Bl dangers of this disease. 

The bromide of potassliim will mndi benefit a cnriovs affection 
wo sonvotimee ineei with of n child, which from tlic limo of hia bjrlb, 
oan swallow Hilidx with ham, yvl in chokL-d every timo he trie* to 
drink. Thia ttrauge sfFoctton is in no wayoonncoted with dipblheria 
or any visible aSvdion, or malformation, of tlie throat. 

The bromides, bo far as we know, appear to have very little ia- 
finencv on the stomaoh. 

Id certain ooaea, these salts exert a benellcial inflnenee on tbo 
inteetinM; for instance, in a form of oolic, which tometimee affoota 
ehildivn from a few months to oni* or two year* old. The walls of 
tho belly are ratnet«d and bard, wkile tbo intestines, at one spot, 
are visibly oontiraoted into a hard lump, tbo sixe of a small or«ngt>, 
anil iJiis contraction mn lie traoeil ihroiigk the walla of the Inlly, 
tnvelling from one part of tbe iotoBtines lo another. These colicky 
attacks, anoonnMtfd with oonalipntioii, diarrboM, or lluttiUqire, ooonr 
very ofleD, aiul ptvduoe excruciating |iain. Sonietiuics tbey ato 



uBOMiDE or niTASSli;». 



161 



•Mooiatod with a chronic! nphliionn coodiLion of tlic rnontfa. They 
gm«rtllj neist nil other kinds of treatment but the bromidiui. 

LJko tbe iodides, (tiuro salui prum qaiclcly into thv hlood, and we 
&hnll now treat of their inflaonco on the organs to wliiuh they nro 
conveyed by lliia fluid. 

The eip«riinenl8 of Brown -S^qturd. Mouriot, and Jimory, load 
Utem to conclndo tliut bromidM oontnici all the blood-^'eascls. pro- 
daoing unemift of the Itrain and spiiuvl cord, thna diminiKhiiig tlie 
oxcitability of thme organs. 

Ootaio eiptriiomU ibw that thi* oinUMtian ia prabiblir oaing to tii« gOcet of 
braaida of poUarina on tbv iMo-motor nvrraai tjiUm. Ths ux um of bMh bittil 
Un ot k frag ««(« quloklj nol olT, wJ ilurlnn Uie (nllowiag tro minatM dghl iroft at 
blood Moved fmn IJic right kg, viJ rnofl inm tbe kft Aoothor tro(. ifUr b«iag 
p(n*oii«d bj bromiJo of {xtUniniD, ■>• trmU'l in lb* mkhi vtj, but Lliiriiig thv two 
miBsUi aAar utipatMiani Iwa iliofH aoiy Sawed trom lb« ruibl leg. The left ■cUllo 
pkxw WM Ibeo divided, tli«t«br faiiiig off aenotu commaiiinllon UIwmii the Utsb 
and tbe TUa-molor ointtw. ud id l«a minaU* ttn •itopt llo««il Irom Uio b>(l Inj. 

Tbe broRiidi^ nf poduwinm indacox in nninula dsoidud diminution 
of rvtiox irritability-, and of «utani^oua sensibiHtj'. Kxpcriiucnla 
render it ]iro>i»btc tliAt this diminished reflex irritftbilitj is duo in 
part to tlio effecta of tho dru;- on tU« reilex f auctiou of the oord, and 
in port to it* vBoct on tho sensory norVBB. 

Tbi* «ffwl U not doe la JU Kolioo on tbe miuolea ot motoi ncrre* ; for. itlcv eotnplel* 
aboUtioD ot nOtx kotloa, iba ihukIm ttill eonttoct on tbi> diracl a|>pl!i:Ktian uf stlvioio 
■timuUtira, cmd tbe iDolor nctna ilUI conTe; imimlwi U tb< niuclca. Moreover, It 
tbo Tcmli of Ibe bloil vxlrtniiliN m* lint •KDrely lieil, aod tb« aaimal tbeii poifonod, 
Ibo kind lap in oommon with otbir pula o( Iho Indf low tlitlr rcflti iiriubilily, 
tbaabg that tbe drug doci not eiptod it* forra on Ibe muelea or main' Dcrrtu, linoe 
Ibae part* in lliv bincl (itremiLir* are proicctwl by tbe liitaiuro o( their vcuelt. 
I'urthw, thU tOBCtUMun La ■IrvaglhoDcJ by tbe (ael that, alter the abolition of rrllox 
trrltabUiiy in a Irog, itU diUnpableof rolaolaiT noremMl. QenoCknot ODljaru Ibe 
maicltB and moiOT ncnn anafloot^d, hut likeviae the mDlor tract of the pcTd. and tbe 
motor oeotn* of tbe bnin, It appaara, Ihaiaforc, that the bromide aSudii onlj the 
pgtax taDOlloii of llie coid, and l»rea unafleoted tbe other parts, oetUinlf the motor 
tiMt. Dr. Amory altiibulcB tbe rfToFlii ut Ifai* I'roinidg on the coed tu Iba eoncnelion 
td the artenoltf, and to tbo dimlnuilon of fnnetion noieqaont ah tie leaunn) xai'plj of 
llbo blood to tbe cord. A ver; doubtful eiplaiulioD thin, tor, in the lint place. It baa 
lot boan Mtlifacurllr proTed tbat bromidea do mntrui tlio arl^riolet ; and acala, it 
reflex aHioa wom <lua to tliia mum, auretj the otber fiioetlDna of tbe cord 
lotd ahan tbit iliipiiatlmi, for it hoidb iaendihie tbal onlj tbe artttioloi nppljlng 
lal part of Iba eoid devoted to nfitx funellun tboold b« aAcled ; anil tuU/, ia tbe 
OBdtei* (rpl, «hen all the Mood hu been waaheJ out of tbo vcmoIi aal rtptaced b/ 
I water, rtOiUrinf the curd oiinpIcldT audnsie, tbe ■jtoptomi producnl bj bnnldea 
net oeour. BromLdM dtpma likewia* lb* aonMT} aetrta, tw It Ju* been thovn bj 
experiment*!*, that an attlmal pobontd bjr bromide ot potaMlan, ytt atill 
of tba po*tr of i«liuitarT noTement, tubiaite to pinabiDS^ boming, or priek- 
viiboBt moving or tiring ether cvidaoaaa et pale. 



1152 



SROVIDK or FOTiSSlCU. 



To|iicKtl7' applied to lUe li«u* op TolnalArj' musclM. it ilealrofs 
t)i«i contrnotilitif, anil topicnllj nppU«il to tbo motor wrvm or apinnl 
cviitroH. it d«strDj8 their fuuction. ThU property prolmUy doponils 
oil thii iKitiMfa aloDc, for potiuh itiilt« pnralf i« fJl tlw strQOturoii of t)t« 
body. (Sec Potash.) 

In ft joint papfo- by Mr. Mnrshrad and myseU, pnbliBhml in tl»e 
/ouriiul t^ Aniitontji aitil rbgiioltiifif, we havu sliown lluil all llio 
offecta tkflcribod as arUioi; from bromide of pataKdnm on frogs, aro 
due to the potAnh, and fnrtlicr, tlint these eSocta an> piodaaible bj 
all potncsinm mils. 

AiU* ■ kjppnlanDia iiijcdUdd of a utatioa of bratnid* of iwtuilaia, in tttm mw !■ 
Ilr* oiwatM M won a* ■ «uidltioii, [iroWtdj das (o frigbl i.ad tbotk, bu fawol off, 
rh* Miiaal nmTon eoa>fl«t*, or alncBl «»mp1«io nlaaloo v^t**. but ih«ra i* Ma- 
■Idanble, uJ In mdo c*k«* isrj oonpltii* Ion ol Mniati<ni ; thoL piDcklntc ■ !«• dihir 
MdUi a» vdoaUrj noitiniiit, or It it maiiKuttd anlf under >hir|< and R|aa<ed 
piadUng. la lii or •ctcs iiiinu(« fKDcrel ntkneu cniun, iind uliiwtjr [■loj w i UIL 
In abonl aa hoar, panl^'u ii oompUt*. Bat batar* tbii Uindnoad, Ibe antoal IIb lUt 
on ibo ubln bokbg d«ad, vblitt pIooblDg euiUt ndtber rtdei nor votuoUrj u4i«B, 
j«t n( t^ tiniT tbo tninul ntauu oDnuOonblc TelsntaTj fo«rr, betng abW w bop 
«i(0toad7, IbooKh ■akwMilIj'. Tb« MqiniM ol tb« ijinplom* lk«n ii, flnl, dial 
ibonl/ atl«( (ha InJKtloD, oompktc, ot kimoit fOniileM. (Kntjaa of tba nftreal 
ntma, vilb iMa or ilaMrmti'in ot nflii aeUon, but with voluittorr |>4w*r rttj liitl* or 
B«i at all alToMad ; ncu fotnalu; pa««r dMlinaa and U al lail abelUhad. W« tal 
Uiat oblorid* wd iodide «t p«taMl«« prodooB IlitM Idontltal pbcountna ; tkat ttL 
lafUil; «l Ui* ton «[ volaataiT povcv dtpendi en lh« laoportioaaM amoual «t pi|^^H 
tbaailt AMtataa. VkutMa)*^ ONd. untar ai pMalUa, Ibo mm* rdalira imIB 
•f eaoh aall to tbc •rii(bt of the aainiolt So a> to pve an o^ niTnli-nl qoaniity of tt> 
patMb, ihsao h1i> taui b» iJniiaUUrotl In il^ut iho rolloaint raiio :_Ciitori>la tl 
Polaailta) t, Uraoibl* 1 -i, lolide 2. Kor *« found iLai, on rui iTonitf. >W ohlorid* 
mtmt «H*plcl« p&nljtii ia M BinBtal^ tbo bromide in 53 miaalM, and IW Mid* ta 
M KtouiPi. Rfona Maallng ia aboat tbo »bw« nilo u tb> ■aouai «f folwli n a j w- 
■Inlf (onUlaoJ bi ihr ihrao oalio. 

Tht olfmi ot bromvtc <f ndtam ii fM lc« nerftlic ; ihu, la tbo rMtio of (oar 
or IItb luiaaUa ill offccla paat oalirol; aaajr, and art, iniltod, pwtaMj duo ta tka 
aMchtBl«Bl Uwb. and Mt to Uio dirxt aMJon ot Ibo Itromldo on tk« norroua li— ■ 
For Um abon nuanavc osnclado Ibat lli« effeeta j<ul doMiibod doptnd oa ibi | iM* 
ta tha bnnlda «t poMaiam, Ib* mm* rMall* bcias inoncibla I7 olbar poUaalan atlU 
Oar aba-rratfaiM, U«*e(<ii«, tbneoatnaOuttaiann'RrfaloaiMlaMnraralaii Iba Mate 
aaltoB of all polawwm lalla on (!■• ncoron* ifMoa of fro(p^ alio taliordtTo atalaaaal 
tbat bnnldo of toliua, otod la ildubl* tho doao of branid* ot potMilaHi, ximiinw la 
tnfi aa rbaimlrritlla tjrmftomi. 

Vory largo Atme* of bromido of pulanaiaru Imuou tho (rvtiUMOOy 
and th« fnrcoof tbo h(*rl'a conttactiniis, «hort<iiing tbo ayatula and 
imilont^ng (ho diastole, and at Uie laitt arrvatint; the hmrl in diaatnlo. 

Bronitdo of |H>taMHinni ia UM>d in » variety of disuuM, 1ml ita 
rirtoea an chirfly omspiciioiis iu l-odvuIhioiiii. 

Itia Mn'ioonbli) in alt forms of convahions — i» 0[iiUp8y, in Ih* 
oonvulsioiw of Origbt's diacMO, and in tlw eonvulsiou of cluUaak 



BROHIDE or rOTASfll DH. 



16S 



I 



I 



Oflurt^ar ^hp to contric or eccentric caiuea. Altbongh convnlstons 
WKfilA excilud hj many canitm, it u prob»bIc tliut tho comlitionii 
of the norToDS centres producing the attack nre in every iostance 
idoDticol; nnd it appcura to bo ihag caiutiticu* which tho bromiila 
oontrolfl. 

In no dinCAM n tho bromido of filfwiiinn mxn tigiuUly offirn- 
oiona than in epilofMy. thoogh it is aob flqull;^ aNfnl in ai\ foi-ms. 
for this drag Imvos Rttaoka of petit mal often nnbenofitod. It in the 
conrnlsivD iorm of opilepay which Ut aa mnukably amenabte to the 
bromidei for in b)' far tli« grotlcr nnnbor of cmos, ihu fita, nnilor it* 
iDfliu>iice, b«coino much less aovere and lens fret(aent. Even when of 
great seventy, and rupaat«d perbapa mvtnl timoM a day, the fit may 
bo postponwl for ireeksi and evtm roonUiB ; nay, in some casm it bas 
boon dekyed for jcw. 

CaMi of tho convulnve form, hoirerer. oocaaiona3ly occur, ovor 
'whiob tJie bromitio appitam in In^ powvrtom; Ibe fita reoniTiny as 
«ft«o and iM KTVcrcly as if nu tiieJii:ii)e had been tsikon. SoniottoiM 
wbto) Ibu Ara!t orroHtH Ihc npilo[iCic ronmUioii. tbu jialient beconec 
doll, irritablo, idiotic, rotiditiuus which on the rvcunvnco of a fit ai9 
reinoir«d. AKain, Uiotigh Ktoppinji: tbc gnntiir attiukK, bromides ni»y 
increase tho fnxjuoncy of the yietit mal, II is nol poMiblo to fomicU 
wluin tlio medicine will siiocccd, and when it will fail. As might bo 
oxpected, the effects of the dra^ are most marked when the disaww 
ia of short standing. 

Dr. W«ir Mitchell recommends lirsnude of lithinm in epilepsy. 

ft oontains a larger porcuntagc of bromide than either tbo aodiua 
or potassium sfdU, and it actii mora jwwerftiUy, so tliat Bciallor doem 
may hr. givvn. Dr. MitchoU thinks iJto litbiiuu salt suooeeds somo- 
tlmce whon the pulansittm and sodinia salts fail. Aa a bjrpnotic. ho 
stys, " it is superior to tho polaetium and other salts of bromine." 
Kcfaererria tLiiikn it is inferior to the poinBsium salt in epilepsy, and 
ft hypnotic snpcrior to tho sodium and cidcium salt«. 

Rcbevorria considers the pota&uum salt mnch snporior in epilepsy 
to the nmmoniiim niU. 1'ho ammoninm nit ia mora diFa(,n«cahIo 
to the lASte. In epileptic maniacal excitement Echcverria tiuda 
bromida of Mdium fkr Ian aen-ioeable than biomid« of ammoninm. 
He moreoTer asaerti tlttl bromidee fail to snppreas mental exait«ment 
in epileptics nnhws combined with some other narcotic, m coninin, 
cannabis indieat hyosoyamns, chloral (1I> to 20 grains each), or, still 
better, ergot of rye. 

Hrown-S^nard thinks it advantagoons to mix tho potaxsinm and 
the amrnoniBm mlts, this combination exerting a groater ioflnence 
on epilepsy than either salt iffparntely, and iMscning tho risk of 
bromism. Uehererria didpatca Iheto Hiertians. 

»1 



161 



BROUIDE or POTASS lUU. 



In tnild cpiloptic nwes. t«n pmns tLrco timei ituly ia tml&ciMtU 
When tke atdi^k oconrdi onlr kt nig;bt, tlm best way tn nvort it is to 
give At bedtamo a fall dose of tliirly ^rruinii. EchavMria finds Uttt 
the ftvemge doNO mqalrcd is siKty grains dailj', but in mvem cues k 
innnh larger qaaoti^ nw^ be nocded. In napect to the doso, ToUin 
Buje, " 1 Imvo employed for tnaoy yesrs a method wliieli has giron 
me the best resnlts. vrliieli codhijiU in determining tb(.< condition of 
nflox nansoa b^ introdncing a spoon as far na Ike epigtottia. I have 
remarked that a tlicntpRntic daiin of the bromide of pota&nnm is not 
nltdJnod til) r«flex nausea is sapprflesed ; it is not till (hen that tlie 

bulb itt wrtftinlv nct«d on, and its eicito-motorj- force diminiiihwl 

Tbe Etndj of other reflex phenomena, suoti as lacbi*)'nialiou, cough 
ftnd BDcextng, eiuthlcc ns to follow the nction of the medicine upoo 
tho balb and epinftl curd. The dose slionld not bo increased berond 
Hic Bnpprmsion of roDex nnnm-n, bnl it shonid bo giTcn continnonalj 
for j-ear« togMJier. If llic malady be aiiwliorated, or in prooeas of 
core, at the ond of two Teans of arafliorntinn, tbo remedy, insUwl of 
being adniiiiktei«d orery day. may bo given every second, third, or 
ffturtli day, provided rellex nausea bo always and oertninly aliaeut." 
Voicin GODsiden that the early manlfeatetion of toiic oSocts is a good, 
and their lute appearanoe a bod, angury. 

If tbo patient ia not curod. but only benofited, by tha bromide, it 
may Iw oontinnvd for months or years- Bat it* administration 
should be sns)iended at times for a week or ten days, or on two days 
in each vfix\:, aay Monday and Thnrtday. otherwise tbo ayBtcai 
beoomea acouatomed to it. when it loaes itn inftneoue, bo that tlte 
f(DOd effoeta, so well marked originally, cease altogether, (he lil« 
rconrrina with llxrir old M!ven(y and fre(|ncncy. If in snob a enae 
the drag is withheld for a time, and then reenmed, it again maaifeats 
all it« prerions cfllcacy. 

II luu been aMorled and denied that ofalorido of pobuninm ia 
vpilopay iaaa efficactonii as bromide of potaMiium. 

Wo hare already spokrai of tJie effect of bromiilo of potanina 
on tlie oonrnlsions Kometimoa acoorapanyiiig wbooping-oongh and 
laryngiaranaatriduluH. Tlie Ixromide will often prove useful ia bU 
oilier dietawM aseociBbed with genoml eonvnt.Hioiiii. Of coorav tlw 
exciting eanw of th« oODTalsive altacka ebould, if jioKaible, bo re. 
moved ; but even when the eauM w indotectahle, this salt will nftoa 
teMHUi or prereD( tlio epitepiifArra ■eianm. Tba oonmlsioni oaaaad 
1)y intmliiial worms sometimes resiat thit moady oompletelj. 

[troini'le of potassium witt often check the oonYuMons nwolUi^ 
from Mni|ite mmlngitU, the lit« mmctimos peraiaUng attoribe doolbw 
of Itiu iiifhunmaUun, aiul iiillkting senous djunage. 

Many writcn latol bronido of putasaiam in teolbing, awrrinf 



VROKIDB or FOIISSICU. 



16E 



^ 



tbat it obristos irritabilttf and rcitlcKness, aod prevenU oonva!- 
sions. 

Dr. Begbie ]ib8 niuob commL'jidrd tliii; mlt as a soporifio. Tlie 
bfpnotio offsets Dr. Clarko and maoy othL-rs coniiidLT duo to tho 
onnmift of tbe braio which thiMn-iinlU prodaco. Tno mnch anwinia, 
he acMorls, induces wnkcfnlncss, wfailiiL a lesa ilPKrci; prodticm 'hvi'. 
In this viAj be explains (he diffcr^iit L-lFot^ts of Imiinido of potusinm 
on hinMolf. Aftor unmtHMl mental or pbyeical fatigue, which ho tuumrta 
onuMOB anDmift of tbo bnuu, forty or tifty gminit of bromidv, by 
■BDreuing the anvmiB, oauaed hleeplusBuuss, ihouj^b it itoathcd nnd 
qtiMted him. When only wnkofnl froio an ordiiuity nnionnt of mont»l 
work, ft xtatc when the bi«n ia iu a hrpenemic condilion, the same 
doao prodnced ionnd and ntfrcNhing itiocp. Qir<.ii when tho brain 
TOC«ivoH only thu luual amount of blood it produces unusually pro- 
found sleep. Voisin, reffrring tv bin pntioiiU tn thu Biofitre, (ays, 
" The hypnotic action upon thorn was very renmrkable night and 
day. Som« were obtigod to sleep for a few niinDt<r« nt n tiine in the 
midiii of thoir work. None, Jn «pit« of whatever eiTorte thoy mndo to 
the contrary, could roeist sloop directly after their ovuniug meal." It 
ha* been found of csjiwiul use in obvialing that ideopletsneai and 
wandering at night, not onfroquonily ocourring dtiriog oonralosoenoo 
from tcato diM(Me«. Often, too, it im of eorvico for iho like Kymptoms 
daring even the febrile stftgo of inflammatory and npuGific fevera, tut 
pnenmonift, rhenmntinn, and typhoid fever. 

Iu itk-i-pleiitmegs from otiior causes, as worrj-, orcrwork, grief, 
dyspopnia, Ac, it may bo boiiofnlly umployod. These remedies are 
evpeeially iudieati?d if, besides sleopleaancea, the pnticnt, altboagh of 
abstemioua babit«, RnfTur from dclirinm, membling that of delirium 
lr«mens. 

Bromide of pot«Bsium is often of conspiooona benefit in delirium 
tremenR, rcmuviofc the deluaioos, calming the dclirinm, and inducing 
eleop; and its cffieacy in most ap|inrcnt in the earlier staftee, before 
tho delirium become* furious. Moreover, it iit of great serviee in 
diapelliug dolasions which may remain after the partial subdual of 
the altiu;k. 

Dr. Clarke rceommcuds thiK Halt in the iuaomnia aocompanying 
meutal anxiety, hysteria, preji-naucy, and " a nort of hypcnnitluviin, 
which I know not how to dewcribe by any other name than general 
Dervona irritability,'' 

To prodopc sl^op, twenty to thirty grains slionld be given at night ; 
and tdtuuld thi» prove ioKufficieut, a liki> done nmy Iw itkea in the 
morning. Likewise twenty to thirty graina, or even morv, may be 
given iu duiirium tremens every two huum till the patient falls 
asleep. Tho salt often suoceadsaa a eoporilic when opiom fails. It 



16lt 



BKOxioE or roTASsirit. 



tnorruM tlio lijr[niotic c^Fwct of chloralt ItfoacpuBtis, bvlltuloiuia, 
caBii&bis indica. etbcr and fliloioform. uid, luxordmg to Dit Costs, of 
opinm. 

Dr. Bi!|;bia rMiommvndR H tor orertnxod limin. eitlier from sladjr. 
or 0T«r-BtreiiDODa ap]>ltrMi(in to banineM- It culms tUu i-xoit«inwnt, 
produce* Nhicp, nud iliHpuls tke ^ddineea, noisca io the cars, and 
permsioDB of the «xt«ni&I sodcm, which oftvu hunum tbewi' ]iali«uti). 
Id each omvm it ii invnlonblfe Ho also recommeods tbis salt ui 
a<;nt« mania. It is Dsefal ton in tlw faMdadiO ooimi-cti'U with grief 
or worry. 

Th«re in n givnp of nfinptoins varionBljr combinod, occnrriug ntostlj- 
in womm, generally towimptioplv. Tho |»tient is very "nvrvotu," 
inbjOL'i often to RTCot despondency, at times so nnmdnrahlo oa to 
nuko ber, u sho cxpivMOfl il, fool a« iri>lii> xhonld go otitof heriniad. 
S)i« in very imt«1>l«, is unable to fix her attention, and noiiiaM distmw 
fa«r. She iiloeps l>ud)y, lior raet being hmkon by haTassiug dieanui. 
Thin condition often arises from overwork, ^ef, worry, or too Ita^ 
rcsiilcnn) in town, or want of ohan)^ 

Tlio tiroinide of potassiam will always oure this group of symp- 
totna. Tbeir onmrreiuic. in(k-{H>nJontly or BMOoiatod with othor 
illiwaaM, as Lhe change of life, or migraine (dok fanwloche, oorvovs 
tii«k headachif, lultous heailachc), ij; a distincl indication to giire the 
bromide. 

The broniido has been often extolled for its eScocy in the symp- 
tom partaiaing to tJw "chnu;^ i>f life" and in niitfiaiue, and ibuni^h 
ofl«a very servieenblo, yol il oftim fails. The distrvioinf,' symi>touis 
ot'curring doHng the change of life are very various, but generally 
ncenr in definite (froapa, though Ibcsc may lio uora or leM eombioed. 
Tbo groap of symptoms I hare just described commonly occais at tb« 
maaopiuso, mm\ yiehla mluosL always to tbo bromidi*. Tlils group in 
oflBO assoviulcd with beats and flushings, followed by free p«ra»pirft> 
tJon and prootratiou, aometimeiji extreme. These tiymptonu loo will 
also gnnenlly gire way to the bmmide. If, however, the boat^ 
flnsbini^ and perspirations prvdomitiate over the mental depnnsioBt 
im-vottsnasB, irnlnbility ami sloei^eHniOm, thon small doHs of nitrito 
of amyl (seo Ibis drag) will generally prove more aerrioenble than 
bromide of |N>laMiam. Whilst ronioviug tlte heats, flasbines, and 
pervpbatlon, tlio uitrite of aniyl oonUols tlie otlier gtonp of sytnp. 
loiDs, qnielji the nervous system, produces sound drNunlew slsap, anil 
ralieveathonurvounniMs and depression. Al thechangs of life patienta 
oftrn complain of much fluttering at Um) heart, a symptom best c<m- 
tn>lln) by huge doses of the astringeni propuntions of iron (Ms Iran^ 
Indood, if a patient ia ana'mic, the hronide or any tnnUnent, tliongb 
aScsioioBs for a time, fails ia tbo long ran. 



I 



BKOMIOX OF POU&SICM. 



167 



I 



Occagiomlly the tronbleit just doaoribed )-i«ld Imt partially to tli« 
trofttmont nioommendwl ; or, if rcmovwl for » time, reonr witli 
grntt«r intently ani! become unendurable. Then the only reeounw 
ix tliomngli cluutgK of uir and sdodc, or tntvcUing for three or six 
montlis. 

Ill mi^TntDo too (sick hoodacho ajuI its ullice), bromide of ]>otM- 
Etniii has been atronijly revoDimended bj- Dm. YiLiidull and DnvU 
ot jViiicrii-n, and lAthnni of Cunibridgv, ftnd it U ofUrn of groat 
■ervioe, though in uany c»at» it oltoj^her faile. In tba ftrtiole on 
(■rolon cblnni) 1 hiivo tnvtrd n[ niigminr. and I liorc< mcrcty ndd 
thiU H6 olten Bnd tin* liL-aiiathe o^aMvintod with the ;froui)of i^inp- 
toniK imrrionsly d«Bcribed, namely, norronK drpraKsion, sleeplMsntvs, 
irritability, &c, PerbapH for yuttm previously th.- patiL-iit had Iwcn 
trniihhxl with nttitcks of migrninv ut ititervalK iif n month or m, 
0» t lie ocyiiu-renM »( this )?n>ap of eymptoms, the attiick» of uiigiuine 
Iwconw much more frequent and wvcre ; indeed, the p*in may 
boocnae oon^notw, tfaongb ftt timee, generally once a day, it may 
\w pftraxyemally worse. Tho irritfthility, shteplamMtiiN. &v., arc indi< 
catiiiiiH of a depremed nervosa syutvni, which auvoimta for the 
incrviued frvqnoncy of tho migrainous attiivi:)^. With tbiH <rondi- 
tion of Iho nervouH nyirtcin, alight diaturbanoesand cansM of irritation 
bring on eerore headaches ; sonurtimoa ao 4«sily induced that tkuy 
occur d^ity. Uromidu of potasBinu produoea rcfretbiiig Hloep, 
Koolheo the nerTonH Hystoni, di«pob tha otlufr oymptoine, ami at the 
eame time loumui the frequency «nd severity of tho headochn. 
Agnin, ilomngcuont of the womb L'xcit«a migrainoUK nttnclcs either 
ata nornialormenorrbu^o period. Hero af^in bromide of potasiuura 
istte(>ti)t. and tts«fficAoy, when tlie attuclcs are oauHvd by Rieii»rrl).%'ia, 
is not futiixily due to it« checking this condition, for, t^veo U-'twuen 
the periods, it may improve tlici migraine bafurv tho noxt attack of 
me&orrbB^ia. Whilst Hpcaking of uteriuo distarbauui) n« an eieiting 
MUM of these lididaohes, I may mention that sometimes thoy are due 
to ntfritte luistrhief, generally of the necJc of ihu nti-rus, and ronmin 
rolx-llioux U> any trcfttmvnt till the womb is cured either by injections 
or by oUier (realiaent. 

Sometimes duriit); an utt.-kck a full dose induces sloop, and after 
a few honm tho jHkticnt awnki^nii frvu from headache. Vnt. Yandell 
and Davis Bud five or six grains gonemlly sofficient, but thoy have 
giri>n half a dmclim tiiroc times a day. lu sevaiv attsoks recurring 
daily, 1 find tifl«eu grains twice during the day, and double that doM 
at night, generally reiiuired. 

Sometimes in tho later months of pregnancy, a woman becomos 
at night the prey of the mwt frightful imagining labouring uuder 
impHMBOD tliat she has committed, or is about to commit, soma 



ItiS 



BBOMIDB or FOTABStUM. 



great orimo or cruelty, na Urn mtirder of lier children or busbiuid. 
Tbo bromido dispels these doltuioDS, nnd indncoE oiklm, ivfrc«JuiiK 
sleep. ypeidrt'icli ^ivus 15 to 30 i;rams daily for vomiting of 
pregiiMoy. 

Rromido of potaaeinm is of Krcnt Hcrvioo in tlic trentmrnt of ohil- 
tlriMi nabjuct to night-scrctttnin^. % eyniptom which appnra to bo 
nllii-d to iiightmnre. Cbildri-n from m fnn- mnntbi* to Hivoral jonn 
old may Ik; atbuikcd with this affection. Soii)i>timra the attack 
oocars only once or twice a wuok, us is usanlly tbe ciu« with older 
childmn; or it may bo re[ieated several time^ each night. The 
acreainiug may lu<il only n few mconds or it may oodurv for aerenl 
honra. While ncreaminf^, these ohildren tn generally quite nn- 
oonBoioQS of n'bat is occurring around them, and cannot rccogniiei 
nor be coniforU'il by, tbcir frirtid*. Tlioy mrt generally horribly 
(rightdwd. A somowhat similAr condition is mot irith in childrou k 
few yean oUI, n HtaUi very niniiliu- to noinnambulisni. but sonictinies 
nppArently atlied to opilopsy. Tlie obild Rele oat of bod while bat 
asleept walks aboat tito honeo, uid performs, as if avrakc, various 
Acta, qnito nncoiuciously. This stage is not accompanied with any 
terror. With the screaming an<1 fright, squinting KimotiDw* oooura, 
which after sonio tima bc«om«s permanent. In these caaee bromid* 
of potas&inm will prewot the Hcrenming, and rvmove tbo sqoinlinif. 
Thia affcotjoii tn children being connected Tcry genenlly with 
dsmnged digestion, tbe eundition of the Nt^imach ur intestines abouM 
he nitvndfd to ; bot eren in spite of this derangement the bninida 
will giro (|uict and refreshing slev]). 

The nigblmare of adullavrill genonlly yield to tbe same medloiiw. 

It is MMjihiiig in hysteria, gives patients greater Mlf-control, and 
prorciits hysterical puruxyanu. 

Dr. Ilc>ghie has used the same salt with great advantage in somo 
casea of asLluaa and of diabetes. It occasionally roUeree the pain of 
iwanlgia. 

It is also used with decided benefit in certain deiangGmenta of the 
organs of geuurntioo. Large doaes are wd to Icnm tlie tuitaral 
meostnial discharge- In some forms of menorrhagia ii is equal, if 
aot suponnr, to iiuy remedy wo pussoas ■, but it is more naofut in llw 
flooding of yiinno: 'bno of old womun. It is very useful in ibe caaa 
of young women wbn m«iAimate too often as well aa too copjonaljr. 
It Rnl ngnlates the tima of the tliKihargo and often leaeana th« 
oiDOttnt U is also rery servicathle in the floodings or loo freqnsBt 
Buottmation ooonrrinff at the change of life, and at tbe aaine Itna 
lab'evM nuiij other of the troubl«a incidental to the maaopaoM, 
Over that form of lloo<tiii)( du<> to uterine tunioura of ^-arrooa kinds. 
ft exerts li.'aa L-autn>l in nuuiy coses than ergot and sonte other 



I 
I 



I 



DBOUIDB or FOTASSIUU. 



IGd 



dies. To check profnttc mntiitmiitiaii, ila iiilmiiuatTntion must bo 
regulated bv thii circumslauce^ of the ntKe. If th« Iors of blood 
oocunoulj at llic nBturiil gieriod, Dm inediouio Je then uotumenced 
•boot ft wook before ; And whpn the menatnutt flnx has censod, the 
remedj shoald be discontinued till thv noxl Dltac!k is about to be^-in. 
On iho other hnod, when th« loss of btoed occars overy two or three 
we«ka, or oftener, the tntidicino mnst \>o givou without i]it«rtiuaaion 
till tlio lOM is contTolled ; and when Iho dischargo has bom brotiftht 
to ita right period and amount, it ia alili desirable to give * few dosos 
for a short time before ench monthljr period. Ten grains thrao lim«s 
s dsj is ft doBO aoflloiont in the flooding of young women, but moch 
larger doses ore required in ihe moru nbktituttt! fornm depending on 
organic changes in the womb, This reimedy bns boon recommended 
by Dr. Bcgbie in pnerpcral mnnin and njnijihomania. Dr. Clarke 
■Jso Bays it minres kl'xuhI excitement in Lhose in»tanceB of hysterical 
«xci(«nient verging on nymphomania. Small date* are tinii vailing. 
Not teas thun twenty grains thri<;e daily will exert a decided control 
over excessive sexual propensity. 

It also retttrnin.-i apennatoirliun. Ita employment should be 
mpplementod by cold eponging of the Kcrotum imd perinamm, and 
the suspension of the teaticlea in cold water for aome minutes night 
fend morning. Seminal emissions are generolly excited l>y drctims, 
which may often be avoided by absttkining from suppers, and sleep- 
ing on a hard mattress. Ur. 0«orge Bird ha« pointed out that 
semin&l emisaions ooour from nndtte indulgence in bed, the emissioua 
(•king place almost (dways early in the morning, during the second 
sleep. Ho recotnmendfl.thorcfuro, that the patient should be roused 
aft«T six or seven hoars' sleep, and shonld never give in to u second 
sleep. The obserranon of thiit iiimplu means will oft«n care this 
othsrwiMi tronhlci^omo affection. Ur. Hardmon, of Blackpool, tolls 
m« that he biix cnrod some obstinate oases of spermatorrhaea, by 
directing the patient to empty his bladder on waking from the Grrt 
tloep sleep. 

Bromides are useful in sea sickness. Tbey shoald be givon three 
times a day and be began some days before sailing. 

It proves useful in allaying vmrious fonus of hypeittsthflsia, and 
sometimoM coses the severe pain of chronic arthritis. 

Dr. Da Costa finda tJiat bromide of potossinm lesaeiis, or eT«h 
pvWTent«, many of the disagreeable aymptomfi of opium, as giddiness, 
confasion of mind, fainting, himdoche, and nickncBS. It manifests this 
effect over morphia and codia, leas tlinn over laudanum. A largo 
dose— 20 gntios — of bromide must be given half on hour before and 
two hours aft^tr the laadanum. Hron lai^gnr doses ant noccssary ; he 
ov«n gives 10 to 60 grains soma hours befoia the administration of 



170 



DROxii)!: or roiiBBicif. 



ihv opiiUD. D* Coate iftys Uic bminiilo i-xuHi aunt oontrol o^'cr Uui 
fAinlnoM. Ho aren ftim that t)i« bromide beif^liteoa the "uuxlTm) 
or hypnotic vSL-ci:* of opiam." 

If Iho modiciuo U (xintiDned for a long tiaie, m is aornetiinec 
n>r|Hir(!iI in the treftlmrnt of c|)il«p*T, tlx! jiliyitiDlDgic*! (JfcntK of tltu 
drng Ijecome apparonti "J>imiaishH] Bensiliilitj, folloirad hj coin- 
|»lvto Dnciitbana of iho $ah pnJate. nrola, nnd upper part of th* 
pluHTttx, ia the Snt BjrmptAm tliat t1i« patient a gvtiinp; nnd«r ths 
inflnftDOO of thc> (trog. T1m> mrxuhI organit are amongrt the fir«t to 
be infla«OL'c(I, for tJieiv is soon prodovi'd fsu'tnre of soxaal vi^jvnr, 
nud.aftera time, minrkcd dimintitinn nf tho wcxnal nppolitv itwlf." 
(Daxirv.) 

Thcao iHTcots raty granllT; in aoEoe the rmnody prodoDiny only 
nndento diminntioo, in otltent, titniponuy impairment. On dia- 
cunttnuinc the remedy, tlia aoxnal oif^s r^imin their lo*l poiror. 
Anotlurr frcquenl rosnlt of tlio prolongtxt nduiniiitration of tho 
bromido U nn eruption, p<n«n>1]j aenofcna, occnmng mort on the faeo 
lUid back, bat it tnny alT<ict I'vcn a lar^r RDrfaou. TImm Bputa do not 
genernity Bappuivl«, nor do tUi*/ scar. Boherema finds that five or 
tvn mininuiflf liqnoranwniottUa.irivRn with tlicbr<)midv. wilt prerent 
Uio ornplioo, anil tha ex])eriooo(i of the KpiUptto iioe|>ital codGtibs 
hint ; and I luivw ocvn ea«OB wli«ro tho nwh biu been quickly remorod 
and sabtMy^iionlly prrvi-nli'd )iy uvmic. I liave fonntt that indidti of 
nlp)iiiri>iDim(^iit,fiv>iuvnl}y applied, L-onNidarably leoaaas tha ()aiin- 
tity and tho eoverily of Uwiw oriiptionx. Tbo elGcaoy of tbo riTmody 
boarn uo proporllun to the aiuonut of acne. Tha binmi<lu aomotinuu 
oxeilua, it is aaid, ocunaa, and Rpota lik* Drytlienia nodoaam. Tha 
nonerorm sputa nuy beeome trae boib, nod tiwm hotlti aoawtJniea 
form tai^ uloon with ooiiinl scoba. looking lika rnpia. Or. Wwr 
Milt-hall narmtoa a auc of thia kind. Ho fonod tliat brotaidca of 
|ii}Us«i»ni, sodium, ammoninm, and lithinm. produoni ihrsa aloora. 
Uv tried aliK> bromidea of cnkniim, magntsinm, and tnvmino itaolf, 
bat as thaw ptvparations failed to rontml l)i« opileptte Dts, tliaj wvra 
B0( bSvoo long Bwnigh to dotormina if thuy too woalil ]»rodiMW tbaa* 
nipnid nil-cm. Ptofoaaor Dnhring, in addition to aciMform paatnUia, 
Miurountva browntab diwnolontioa of tbo akin; atnpio papular 
eruption; confluoiitar mollBsooid none; maanlo-papnlea, CMrbuncular 
acur, and bulla* and rupia as tho occasional oonsaqnenL-ca of hromidm. 
Undno iwlministrMliim of tho hromido reudcTa a patient low-apiritoi], 
tiaaily fati^od, and unHttMl for work, ayinptoma which aoon anlaidv 
on Ihii aiiipt-naton of the mndicino. 

Afno, and the otiMrr eridraoea of bromion, rarely ooouTt nalaaa 
ni>>n< tlian onif done, kowuter large, ia takon daily. 

il, itabutcaa aays ihat broruido of potaautiin may be det«ot«d in 



ACIDS. 



171 



the urine And ■iLliv& tnronly dn^ kftor the Mlminutnttimi ■>{ ft dmw of 
Gtteen gnunf. Dr. Aiaory ocralil not t'uid it more tli*u furtj-eiglii or 
fiftytwo faotiK ftfler a nnftlc doso, but after the drag liiul bcpij tuken 
ravi^ml dftTB, «iul then dtsi-oulinned, be oould Bud ovulonoeH of it &{t«r 
a loi^cvr tiino. Elimtafttion by the nrine U lew rnpiil thna iilnorption 
b)' tk« atomftch, Tntcn appear in Uio uriuo in ti-u mliiuti'^ Elunt- 
nation is iDO«t nctiro during the first niglit or ten luntrs, utd in lau 
than twenlT-fonr hours tlio greater port disappears. It can be 
d«tOct«d in the milk niul swcnl. 

Broiaiile of polaaaiou ia convenientljr odiuiiUHUired in beer or 
milk. 



THEORT OONCERNING THE "TOPICAL" ACTION OP 
ACIDS AND ALKALI KS ON SECBETION. 

, £lVnD!M'i0'tnstng in detail of aeids mmI dlodiea. I wisli to not« 

' ttliRnidHBB'iaB'tilBaMrolioss of tW body, and to draw Att<-ntiuu to a 

theorjr wkioh t tliinic csplniog tbeir action in thui rvAjwoU and, at the 

same time, serves aa a usefal ffuido to tlieir oorract empliipnvnt in 

di>«aiw. 

Acids art* powerful stimiUanU of salivary fleerution : the iiaprMsion 
from UiK uoid it eondnuted to tho Hptnnl cord, and llicnco rufleotad 
through tho cerebro- spinal nerves aB])pIjiB|? the uJirary glands ; anil 
U tbotc tttv diviili-d, aciiU coam to auguont the salintiy awrocion. 

Ropeated and oarefol cx])erimenta bare eatabliabed tbe fact that 
dilute acids tjikun into the stomach, ehock iia «ecrvtton : alkalies, on 
the otUoT Iiand, powM-fnIly exoito tlie wcretion of Uio (ftistrio jaioo. 

Acidn, tlicD, cltcck aoid, bot incrouso alkalino secretionH; whilst 
dilnle alkalies stimulate add aeorotioaa. 

From t)i(SD favtK tlu' more general law ta iDferrod, that aoida, 
applii'd topically, vbeck tho [imductifinef acid MWretiuna from glands, 
while they incieaeo the How of alkalino secretions; thv wry revom; 
bedng iIm oase with alkntics, for alkalies applied to tlie orificaa of 
glands witli acid aooretions, increase their scciroting powor; while 
alkalies applied in a corrosponding way to glanda with alkaline MwrtN 
tions, leasen or check thia seerelinn. 

la KDpport of tlie generalisation I have ventured bapropoxo, I will 
DOW adduce ximo practical instances of tbo officiont tbcntpontic em- 
ployment of acids or alkalies. 

I'bo sweat being an acid Mcrotion, the Kponging the siirfaco of the 
body with aater wenkly acidulated with acids, will in many caaeH 
cBoetually control prafDao porcpinktion. 



172 



ACIDS. 



Acida are useful to aJlftj- tliiraii bj- promoting, through their toptoal 
ootioo on Uio mnconH rocmbnuiK, the Hucrclian of tbu nIkHliue aftlivu. 

Aoida given ahortljr before n lucsl g«ner&llf chock aciditf. 

AUcAtii'ii given sliortljr beforu u ucttl incroiute the aecntJon of the 
acid gastric jnico, anil so promote digwtion. 

A weftk alkaline lotion in often ntwfial in the vrocping 8t«gc of 
•csema, by chocking tho alkftline waterj oxudation. 

A weak alkaline injection is efficacious in that fi>mi of leucorrhaK 
dujwnding on a too nbnndnnt spcivtion from tho glandaof the os utori, 
the aecretiou in tliat part being lUkuline. 

Some of th«M inBtancM will rocar in gronter detail in their 6tting 
plaoea in tJtia rolume. 

Kobne, in bis PKytwhyiait Ch<ni>utiy, tnakes soma statonioats 
ftpporentlj oppoaed to thiH general propa«ition. Ho amert« tliat 
ftlloUiiM u well as uoids, stimnlato the necration of tho anb-maxillary 
gUnd. The secretion produced bjr alknliea in thick, whitish, and 
cloudy; bat that oxcitt-d bj- acids is clear and lorn viscid. A diffvr- 
ence in the ohataotenof the secretions from the sub-mazillarj' gland 
is observed, according as tho corebro-«pina] or sympatlictic nerve sup- 
plying this gland is irritated. IrritAltoii of the Hjn) pathetic exoil«s a 
aocretioR iilt-ntical with thut ])rodiicvd hy alkalies ; whilu irritntjon of 
the corebro-Bpioal nerves excites a secretion identical with tJiat pr»- 
duued bj acidH. Hence it is inf<!rrcd tJiat nlkalic* act on this gland 
thn>Dgh the sj-mpnthotic, and acids throngb the oerebro>spinal nerrea. 

No doubt the saliva, produced bj acids, and by irrilatiOTi of the 
cerabro- spinal nervn is a tme secretion ; for it is abundant in quoa- 
litj, and qntckly changes stMrb into sognr ; lutd irritation of this 
uerve so greatly increaM<s the flow of blood to the gland, that its 
veins pulsate, and tbcir contained blood is c>f a briglil art«rial tint. 
It is doubtful, however, if tbe fluid produc«d by tho inHaence of 
alknlic*. or by irritntion of tb« sympaUietic nerve, is a physiologioal 
•eeretion ; indeed, Kilbne thinlca it is due to rapid degenention of 
tlM gland. The (jiinntity of fiuid produced by alkalies is very snwil, 
and that obtaini-d by irritation of the sympathetic is anid to requiro 
many honn to produce even a trace of sngar in a solution of eUrcrh ; 
but nweat reMuohes tend to show, that this sympathetic aocretioo, 
though scanty, does vei; readily convoK st«roh into nognr. Tlw 
flnid thus obtained, contains )arg<i quantittea of very pale gelatinona 
bodies, of diCTorent forms and sixcH, compoeed ]iartly of albumen and 
partly of mucin, lluroovcr, by the irritation of llie syinpalhetio nerve, 
the flow of blood to the gland is retarded, and tbe blood in tbe vuins 
bocomea dark and Tenons in tint. Alkalies prodnoe very UUloaaorn* 
tioB trom the parotid gland.and so farasourprMOni knowledge goos, 
oone is excitod by irrilattonof any biKuchea of the syufiatiielifi aorvib' 



ACIDS. 



173 



SULPHURIC, HTDBOCHI.ORIC. NITRIC, PHOSPHORIC, 
AND ACETIC ACID. 

Thk roembeni of this pronp nre powurful aciO*. (vud iieoordm([Iy Iiavo 
a strong nfflnitY for alknlios nnd biMos. Some, lu snlphnnc ncid nnd 
pbospboriu acid, nbiiurl) vtiiUt witli ariditjr. All [iohsuimi )iii;b diSu- 
Mon>powor, and so pom r«uli)j' throngb (inimftl tnomhnui<<8 nnd 
textvras. Tbrae oro tba properlioH wliiob explaui raoHt of llieir 
■ctions on tho living body. 

Th«e acids, vrb«n oonoentrated, produce decided chani;;oa in tho 
skin bf tbeir aflinity for the bwuK and wat«r of thr tiKKuiw, im vckW as 
ID a tnitior degree for the organic auLstunoco thetnselve«>. Tlieir great 
diftnsion •power enables ihvra to pcacitral« rciwlily and diwply bcnwitb 
the surface, with a continuous doatrnctivo action, till they are diluted 
with water or n«utml!Kcd hy tlio bai»>n of iho animal strttotimw. 
From tUeir great affinity for water, sulphuric acid and phospborio 
arid Are especially cncrgeliu ; iht-y withdnvw this oloniont from tho 
tvxtarra, and tbttx i-ffoct tbuir uutnptetc destmolioD. In adeijuate 
quantity, tUoy will destroy the tijKcnco to a eonsidemble d«ptb, utd 
prodnce a brown or bhuik oscbar. 

Tho remaining members of this group, owing to their feeble affinity 
for watcT, diintroy tlio tissuea less extenslrcly, and their action is 
much more BuperfSainl. 

Sniphnric acid and phosphoric acid oro never nwd nndilntod, on 
acoon&t of their physical action on the tiasaea. On the other hand, 
nitric acid ia frei{nantly employed tn destroy and remove the surEaco 
of foal and unhealthy slougha and ulcers, and in virtue of a property 
of which we abmll shortlj Kp<?ak, it changi^M on nnbealthy and indolent 
tore into ono more healthy and prone to heal, It is frequently «m- 
ployed in oases of soft cbancrc, indolent and broken bubo, oinenuD 
lalrialis, &c. 

Nitric, hydroohloric, and especially anctic acid, niay produce sorao 
reeication. Nitric acid colours the skin cfaoraeterUtically yellow. 

Tbey are often used witli the bedl retults for tho purpose of excit- 
ing inflamnuition. It JH now ortsblishod that two diseased actions 
mmot co-exist actively in the same part, and on tliin principle) wu 
nw one or other of thit three acids, nitric, hydrochloric, or acotic ; 
for inotance, wo apply an acid, usually acetic, to a pali-h of berpex 
ciroinnatus, anil than establish in its place an infUiuniation which 
4]uickly anfaoides, at onoe cutting short a diaea«e which lends to 
spread nnd to porvist for a uonxidomblo timp. No trcatiuent ia 



AOIPS. 



or more Kpeedir or certain in iU action, than the nfiptimtion 
of Ntrong Boptio nc'ul to rinfrworm of any part of the body i>soe|il tb« 
scalp. TIttiH, too, it ifi, that nitric acid induoes a bcftltbicr bclinn in 
intlolent ulccrt, or arreata tbo Kjirvadtiig of lUongliing sorm. 

Aoel.ir Boid, and sonwwbat dilu t«d nitric actd. are (reqnMtlj ap|)ltcd 
to irarts, wliich nre dostrajrrd hy witlidmwing tho bn«M, and I^ dia- 
solrin^ tJio tisaoea o( Ibe wsrte tbcmselree. But altbon^li Mijr of 
the«) acids BTO vffoctnal, and in vamny cucn completely removo tb« 
wwiy frrowtbs. yet eoDwiinied a frosh and alnindaiil oro)> aprintnt np 
in the naighboarliood of thosa nndnrgning traatmpnt. Dr. Qoorgo 
Bint fiihla tbe Kl*c!al aootic acid vary cffcoUud in rvraoviiig mu-ty 
grovrtlur. SmM gypbilitio mrtti and conctylomata, kept constantly 
inoi«t with a «raali uf diluted uilrio acid — » dtadmi or two of the 
dilnt« acid, to a pint uf water, is Kiifficiont — are tlinsaaivly and pain- 
lOKxIy disiirrsed. 

The meniboraof this grronpnromorogoiuirally fintployedoxtomally, 
mixed with irat«r. AlthnuKh dilut«d, tlwy attlt excite a ))Ci>elloial 
irrilAtion, and may Iw nwd ok Uitiono in articarin, oontrollin); 
the very Iroableooma itchintf, ev«u imrontuif; tbe foruuiion of 
wbealti, and in Monut caaos, appearing to b<i mainly instmmontal in 
cnrioff tiui disease. 

Adda, oq)eaially nitno acid and bydrocbloric ncici, are 1cm oraployad 
M batlis tlum formerly, yrt, Ipcyonii <li>iilit, tlicyoxirt a very poworful 
htRnamra on tltc nkiu. A gcuvral batb, uilli two to eight ounma of 
tbe stnnif:: nitric or hydrochlorio acid, ia a very active Mciter of a 
torpid «kin. Whether these batba hare any o(Tt«t on tliv other urgnnti of 
the body, ia at prmmt tinilc unkDown, no experiinant bavts); boen 
DUdv to itpltUi Ihia iini-atioii. It in hiRltly probabia, botvuvAr, ihnl in 
ooBunon with ulhcr niatorials diMiolroil in batlia, thmn ai-iiU ri.-niniu 
aiiAbKirU»l h}- ibt- akin, and that any clianga in the deop parts of thn 
body TetnltinK (roin mcdicatod baths, must be ascribed to the diixTci 
action of tlu! dioolved uateriala on tbe akui itwif. Siiongiiig tbe 
aurfai-e of the Ixxly with water wnakly ncidnlated with ncidi, will, in 
aomv oHi.'n, vlTectually cunlrul prufnse awntUng, lln' airout iMinjt aa 
acid aecrotioo. 

They, however, act as stimnlonta to the akin when atripped of Ita 
cntiola; thus nitric acid i« (nqut-nlly used irith muob btmcfil lu a 
lotion in tho trattnicnt of indolent and painfnl bIcvts. 

Appli<<d In tlid Kifter tiasue*. the dermis, noeoaa dombI 
Ac., acid* act bn astringfuniai conaing a direct coDdenaitioa of Ih* 
tiasnuf, pnilulily by nrmuTinK pnrt of tlie Ii«m by combiiiatioa 
witli wlik-li tho allmmiuouH nuliaUini'M wore held in the entable form. 

Qy virtue of their aatringenoy, thuy check profuse aeoretions fmtn 
imhatlthy wraa. Nitris mad ia Bost prelemd to mob omm. Niuio 



AOtDS. 



175 



ikcid U gencrnUy nacd w a test tor nibumon in eolniion ; it pr««ipitatM 
{he itlbnmon bjr ftbrtracting tlio base combittcd wiUi it. and in Mttiai^ 
tJie albanwn frw, roiirertu it into an injicitublo subatiincc. 

Wbpn dilnt«d, tbesn acids wry cSui'tnitllj cbct-k bluL'ding £rnai tiiv 
smaller VMada and cnpillariea b; const riuging tlie tissoeif aacitint^ 
iha ninaoaUu' ooat of the artarioK to contract, mu! \>j coa^lntinp tlio 
blood in tli« enda of the wounded reaiiotji, aad ao pluf^u^ lb«m. 
Viiu^^, always at hand, will cbcclf blocding from IcocU-bittiR, piles, 
outs, Aq. The rtnegnr sliuuld be diluted. 

Tbew acids prodooe the same cdcct on tlu: mncoaa iDoinliirano of 
tbe mouth aa on tbc Kkin, and for tbe moat partaro need for tboamu 
I>BrpofiOB. Strong nitric a«id is often applied to fonl »iid sloughing 
nloen of tlio mnoona membntne, to cliatiffO tbeJr cliaraotar and to 
chock their progreaa. 

Aoid* arc. in part, ncutmlixed by tlin alkaline accretion from the 
fl&livBiy glands, ntiile ftujaoid remaining fi-co procipitntcs the mucons 
coating of tho mucons membrane. Mid iC in tiuQioiciit quantity, 
Attacks the mnuous membrane itself. Tboy act Itonoliciull/ as 
■atringcuta, wlicu tbu lining mcralnnne of the mouth is rulaxcd or 
nloeralod, as in ukieruled stomatititi, Mtlivstion, Ac; bnfc otbrr 
Astringvuta nrtt prufcmhtn. Thue acids being apt to diMotvo the 
cartliy coustitueuta of the leetli, should bo taken through a quill, a 
glass tnlw, nr rwjd. 

Nitric acid exerts s fni-tber action on tlic ranoons mombran* of the 
iDontti, and may be given in nnalt medicinal doMB with coitspionona 
hcnetil, when this nicmhrnne is inllamed or discnc^! in Tarious wayiv 
nis in ulccTuted sUiiuutitis, a|>lithte, nalivatiou froui mervnry, nr when 
mldcuvii, inflamed. and glased, a condition not unfroquootlj met with 
in great irritfltion of the iligcvtivc urgiins. 

These, with other acids, aa citric, tartaric^ Jec, qnell the thind of 
foTcr patients much more effectually than sim[|}u watoi-, especially if 
the drink is made rather bitter witli souieagrwabla-tasting substance, 
as otangc-peol or cuscarilla. Mnoh of the troublesome ihirstof teten 
issolely due to dryness of the month and throat. Thia disagt«Ml>lo 
local sunsntion of thirst, is very liable to lead fvrvr patienta to driulc 
more water than is really good for Ihem. producing low of nppotile, 
indigastion, and even diarrhoea and flatulence. ( I'Hi' Water.) 

The action of acida in loaaaning tJiirst, haa already been exjdaimjd 
in tlu ohapteraon the topical aotion of acids and alkaliea on the soon- 
tions. Aa we have seen, acids probably increase alkaline secn)tioafi.aud 
thn£ tlto acid drinks used by fever patients pTumolo an increaaod 
■euretiun in the salirary glands. Ritlers. ati wo shall proseucly see, 
poasOM tbu tamo power ; hence, iioida and bitter drinks acliiis on the 
aaUYai7 ghuda, keep tlie moatli and tliroftt comforlabty moist and 



17C 



ACtCS. 



qnODcli tlie tU>»t. hj leaaenuig the hantfiun^ tliirsl, ikej comfort 
th« patient, quell irntnbility of temper, broar steep, qnict tiic pnlao, 
Aod diniinUh the b(*t of the body. OrgMiia acids ara laj^ly 
emptojed as fever medicines. 

AoidH nre iippliud to the throat for th<! mime pDTpOBe lu to the 
month. Undiluted nitric ncid acta beneficially aa a topical applica- 
tion, on the foul nlougliit or iilcera oconrring in the oonrao of coorlot 
fever or other di§«isea. 

Bretonneeu wftrmlj rocommendM tho application of iiLrang hydro- 
ohloric acid to tho tbroat, in diphtheria. The acid aay be niied un- 
diluted, or it uaj be miicvd with an eqnal part of hoiier, which (nres 
the mixtnre consistence, and malceit it clinj; about tbo [>arta on which 
it is paintiid. It tiboald bo applied only to those apote of the mnoona 
niuinbmne attacked by the diphtheritic inflamnuktion, wul not to 
tbo neigh bonriog hcnlthy tistnes, where it would prodnoe aotiTe in- 
(Iftmcnation. The diphtheritic membmne heinfr very prom: to im- 
plant itwlf on ui6nni<Kl NBrfocM, the application of tho acid to the 
Kound ti«sueB, by exciliLff ioJtamiaatioo, mi^ht &votir tbo KpreAd of 
thediscMO. 

Laetio acdd is largely naed tui a topical applioation to diaaolfs 
diphtheritic faUe menilirane. It may be used aa spray in the 
stron^h of 3)pi. Ut 3J, to Jj of vr&t«r, or it may be mopjtcd on thu 
diseased part«. It should be nited every hour, or «ren oftener. 

Nitric acid, in snudi medicina] doses, may be given with Wncfit, 
wImh tbo throat proMnta tlu> wime ftppeannoes as those of the moatlt 
pi«riaaa)y deeoribod. 

Tb« albuminous Ron»titnent« of food are digrated and nndcHid 
nolnble mainly by the agenoy of attida, but all aoida are not equally 
efficient. X^actic and hydrocblorio acids far outalrip all othen in 
thia rwpcel, while anlphtirio aeid hindcra rather Uian pminotra 
difiwtion by precipitating the albomeiM in an insoluble form. Tho 
action of aeida on nitrogenooa anbatanoe* la intensified by tbeaddittun 
of pepsin, 

In scanty aocrolion of fiaatrie juioe, dilate hydrachlorio acid may 
be employed to aasuil digestion. Tho oonsiderations develojMd in 
the section on the topiojil oetion of acids and alki^ien on the r>oervtion», 
tender it obviooi. that the time of adiniiiislration, in reajwct to 
meals, is nll> important. If given before a meal, acidH chi-ek the 
aocretioa of tbe acid gastric juice, and so hinder, instead of aiding, 
dlgefttni. Where theaeoretion baconty, the acid muatbegiven aft«r 
Iha mtai, when the aeoretion frum tht- nu-tnbrane of tho Btomacli ia 
ooBploted t the ailditienal acid will aui/^l tUe at-tinn of that avcrelMl 
Datnmlly, bat too ooaBlily. In nuuiy cases of atonic dyHpepaim. 
olluliM are prvfernble tu acids, but they mnat, uf eontae, bo yitm 



I 



ACIDS. 



17? 



i 



¥ 



a Hhort time licforc it meal, because llien llioy stimnliite an abandnnt 
secrotion of the t;astria jaicv. In most caM» of atonic dfepoimiii, 
nlkidiui given with the precautinna not^d, ar^ superior to aoida ffivon 
after a meal, nlthongh, M is well knnwn, cwrtnin casoB oocar wlinm 
uciiIh answifr hotter than alkaliuH. In such cnsefl, the mucous mom. 
brane ia presnmakljr vonsidorublj diuna^ucl hy cxccesos in eating or 
<Irinki»g, Mill owing to degeneration of the glands of the stomach, 
no atimultuit c-ould oxcite a titifncicnt flow of gOMtrlc jnico. 

Acids, as wo luive seen, will check or IcMon ibo secretion of gastric 
joioe. In many utomaoh diseases, or fr<iin Ua Hvin])ivthj' with distant 
OTgtaiM, the foIliclcH poor into the stomach an excess of acid, whioh 
undno sccretiou may be checked bj- the adminiittmtion of acidj« 
e&orlly before food. But acidity of tbo stomacli ta often doe to 
flxcMKJTO or irregular (urmentation, loading to tbo ]>rodnction of a 
large quanlity of vnrinns acids, as acetic, butyric, and lactic ; aud 
this excessive or irre^'ular fermentation of lundK i» ttsclf chucked by 
ftoids i and as tindnc secretion of the gastric juice, or exoe«sive forma. 
tion of acids by ferraontaiion, arc the two cAtiscH of acidity, we havs 
ia acida tltenwelres, remedies ablo to control and chock tho acidity of 
the Ktomacb, nnd relievo the consc-cjui^nt di«treniUDg xymptoms, whether 
due to pregnancy,* uterine disease, calculus of the kidneys the varioiu 
iitdigwttons, or more sertous diaoawM of llic ntomacb. 

Practical men, indeed, know well that the Admini«tratioD of an 
acid, will remoTO ncid crootations, hetutbtim, and the iien»c of dinconi- 
fort at the chest and epigostrinm, arising from oKcras of acid in the 
Ktomitch. Hydrochloric, lactic, or nitric add is ^nt^mlly preferred, 
and small medicinal doses, separately or combined, aiv ordinarily 
mifficient, provided tho prcscrilwd conditions are obeyed. 

Patient* are Komctimv:* greatly annoyed by ernctationK of an 
offensive gas, with the odour anil llavour of rotten eggs — a gSH 
evidently coniiiMting largely of sulphuretted hydrogen. Tho lato 
Dr. Day. of St, Andrew's, nodend that in iriinh cnecn tho urine in 
loaded with oxidic acid, and in their treatment, be strongly rocom> 
mondod the omploynient of mtnoml acids. Dyspeptics with oxalio 
acid in tho ttriiie, who KulTcr from great mental deprcwtion, bat who 
nre free from Halphnroltod hydrogen eructations, lind much bonelit 
from nilrio acid treatment. 

tn the troatutent of dyspepsias, a cine to tlto administrntioii of 
acids on tlto one hand, or of alkalies on the other, may sometimes 
bo obtained by tasting the reaction of tho flnids ejected from the 
atonuuih. Xot unfrcqucntly, soon after a meal, a finid regurgitalcs 

* Tw9 «r IbtM Atoim of tinolnrc e( aoi Tomics, Ukca s fcr mJnuUa Mote 
•SMii «ill ufUn nbri^ tbg kIcIiI; oI pngMuej. SoiiWtiiuM iptueuuilu will 
«aalnl Ik 

N 



178 



ACIDS. 



nbnort nnconxcioiiHljr into llio mouth, ttome tiiCL'H to atronglf Hold 
Uwt it mis tbo paticoils teeth on edge. Tlw «xhibitioB of nitric or 
hfdrochluria ucid •hiM-Ur before oHiOli meal, ■Imiittt imineduitcly 
nmoTM this acid pjrosia. ^omotimes the fluid of pjro&is luta an 
iilkalintf rviuTtion, oft4.'» accompiiDiiid with inucli diatrvxx, with nnuMua, 
and vomiting of tlie jnBUeaton food, uid the rojoclod cootenta of the 
stouiacli goDBrnllj show a «tTX)iig alkaline niaution. Hiire an acid 
iiuuiodiatelf aft«r a ineal ivli«Tca tJie nnosea, the romitin|f. and all 
divtruMiD^ H^mptoniii. On IhcoRitical gronndK, vrc Klioald BxpMt 
tbataa alkali, admin i&t«red sliortlj' before food, would yield even morv 
fiutisfador]^ ruitaJte, but in nuch ciuraa I hitve hud no oxporieuoe of 
alkalies. 

It n«od hardtj bo repeated tlutt acids fiivcn Koon nftrr a moAl to 
patients tioabled vriLb aoiditr and heArlburo, groatly aggravate tho 
BDlforiilg. It is adding; fuel to firo. If oontinnvd too long thoM 
retnedics roajr not oalj check xindno aciditf of the stoinaeh, bat erca 
exoe«d this office, and by IcHmniuj; the secretion of gaxtric jaico to 
nu nndue esteut. aotaallj- iadnoo tho very opposite ooniiition to that 
for which, in the Bret inatiuice, thcjr were employed. Those who 
havo watcbnl the action of acids on the stomach, iteW know that if 
loo long continued, the improvvincnl first notioml eonsea by degnws, 
then freali symptoms arise, which, sLmn^ly enongh, are rclicvvd by 
Urn Yorjr opposito trcnlinent wbtch liiid prcTionsly benefited. 

Too long a ooorae of acids excii«s catarrhal infbunmatian ot tho 
mncoos coat of the stomach awl int«*tinoe, often accompanied bj 
diarrhoea, and even by general wasting. This damaging action uf 
nvida explains tho occasional thinning effects of vinegar, when talcon 
for a long tine, by (at people. Vioogar ia HometiroeN taken anmf>> 
titionaly in wiosglassfuU Mwral tiuoa a day to reduce obesttj. Tfciiii 
foolish ptnctioo, which cannot be too strongly oomlomnud. may thin 
tli« patient, but it does so at the expense of seriona injoir to tho 
bwty. Obesity cikn be reduced by hannlwa means. 

Thflso acids are inuporative to chuck the growth of Hinurue in the 
■tomauli i and they often fail even to chock tho acidity aoconipiinyia^ 
these growths. 

ItiancoDunon practioo with drunkeii soldiera to drink a wine- 
gtosafol of rinegnr in a tamblcr of water, to cut short intoxieation ; 
bat whether it does sober a drunkard is not certain, Inil it aeana 
lo eteody a tipsy soldiur and to unabJo bin to pose muster on pmimt 
log himnlf at barmcka. 

By virtue of their astringent aolion, and their power of enapnlatiav 
the blood, acids arc useful in bleeding fron the stomach, ^^iitphorio 
ooid is generally prcrerrvd to the other uenbora of thia gron|>. But 
ouny other astringents are surer. 



I 



ACWi. 



179 



I 
I 

I 



Owing to thoir Iiigb diFfoHinn-powier, thew n^iiils poM niiulil^ from 
tbe atomaeh into tho blood. The acids which pass into tlio iotestiuea 
tnnst, to fi great extent, brcomc nutitmliu!!] bj thi; iilknliim of ihu 
bilo rind pancraitic jnioe, tind tberefori>, as ncid^, tan. by direct con- 
tact, ftffect to » very KmiiU cxti^nt tbo niiddlo and Inwitr pnrt of the 
intvstiiiAl tract. But as tbej- become neutraliited, some of the biliarj 
*ad weak«r acids am iwt trwf, hoight<ining in xnmc dc-grvo tlic acidilj 
of the rontcntu of the inti-atines. 

Dilute acids nrc used us nntidotos in poisoning hy allcttlic«. It 
hn« Wi>n *hown experimentally that acids supplied to the tuncouH 
membntno of tbo duodenum cancc an incroiiw^d fiowr of bilo, attd- 
ImUti to the conaecjnent contraction of tbe i^all bladder and bile 
dads, 1 suggest' that pnrt at tcnstof tlii* nngniontpd flow is duo 
to in(ny<iM!d Mcretion brought about in accoRlanco with the alkali 
aoid (V. Section 7) throiy I harv proponndKl, the acid conti-ntit of 
the dnodcnnm stimnlatiog the seorutioii of the alkaline bile, and 
tbe Htill more alkaline pancreatic jnico. 

It hiiH lonn: bi)i-n hHi! thnt nitric acid ncU in some waj benefictallj 
on long-Rtauding diseases of tbe lirer, ns in chronic congestion and 
cirrhoKis, and that it vUl augment the flow of bile after the liver 
has strtiok work from the excessive use of morcnrjr. 

Krom hi« ospcriinents on fnntinK dogs, Rutherford ccinolndes that 
nitro-faydTochloric acid ic en hcpiilic sliroiilnnl, thus continuing' tbe 
conclntionK founded on clinical experience. 

There c&n bo no donbt that sulphuric acid is highly useful iu 
dtooking snminer and choleraic diarrho.^ although, ax it is gcner> 
ally admin isterp«l with opium and wnrm cHnuinatirce, it is difflenlt 
to diHtribtilv to enoh remedy ita oxnct sburc of merit. Its modn of 
action is less obvious than its efficdcy. It may control the forma- 
tion of acid in tbe inloittiocis or it may act as an astringent and so 
check diarrhcca. If, then, it nets as an astringent, as the nrid h 
•non ncntralixed and conrertt^d into a snlpbatc in tliu upper piTt 
of the iinutll intestines, losin;; ita astringency at once, its iuflut-nce 
on tlie low«r and middle part of the small intestine nitist be nxortod 
throagh dctvobb aympaihy between one )Mrt of this coiutl and n». 
other. Solphnrie acid i« considt^rcd to net ofton capriciously, giving 
riso to much uncertainty iu its adro in i>t ration ; but the lack of 
uniformity in itit results can bo accounted for, in many instance)!, 
by tbe dose; a (mall medicinal dovo often benefit*, irhilat a full 
one, by increasing the acidity of the canal, may ov»n aggravate 
the diarrhffa. Dr. Ncligon, and other autkoritiee, recninmend it 
in chronic dinrrba«, and to control xho "profaso sweating and 
ool3iquntivediarTfa<Ri of heotic." 

In small medicinal doses, nitric acid is of great nse in many 

Hi 



180 



ACIDS. 



diftrrhcBM ; if oHoo ncW ailmirnbljr in the ntnuniag diAtrhoBa of 

cfaiMren. when Hxe mntinus ftre groen, cnnlleil, and miied with 

mncns. This fonn of diarFhocn yicldK xpcTHlily to ncids, wlttcl) 

(•countemot tlie acidity o( the intestinal canal, on vrbioh thiH flux 

< deftends. Tct. on tho wliolo, otiior romoditw »n to bo prefotrotl to 

^Midit. Nitric acid nuiy somelimcH be used with great twDelit, 

leepeciallj: when given with popein, in that chrome <liarrh<aft of 

children whni th« [lale and [Mcly mo^ous taatHl vonr and dJaug 

able. 

Strong nitric acid in an eB^ient remedy for iDt«nuO pilea, two, 
or at moet tfareo nppliondona to the cuUigcd and ditatod vcaMl 
bcin^HafGoirnt; it xhoald not be npplied to the wbulo Kurfoce, ba 
oulj' to oim or two pointe. It is nscfnl, too, in granaUr or nlc 
Atcd pilre. It prodnccji liltlo or no ptun. A enperflcial sloagfal 
fblloira, and n(t«r the BOpamtion of the slough tho contraction of the 
eore diminishfiB thn nzn i>t tlie pile. A drachm or Uulf a dr«chin 
of the dilnt« nitric acid to hnlf a ])intof ml«r, is an cxcollont lotion 
for blooding ]>ilr9', Htnying th« bll^nlorrbl^^e. coDiitriiiging tlie awollcn 
and inflamed tumour, and oaeing tlie lioavy, tensive, wearring pain. 
Aoids nro rcpuu^d to lieighl^a the action of pargatire modicincB, and 
for this purpose sTiIphnricnciil is somotimes employod. Sulphnriu 
acid incrpasoK tho ptirgntive efleot nt extmct of aIock. AcitU aro 
usnally added to pnrgaliro saltn, as Kpsom salt, when a tonio 
bracing action on th« niucuns niembrano i« dckirctd, as in manj oasei' 
of ansmia of jonng women. 

If not olroadj neutmlicai] on tlicir pcuwn^ into tlio blood. Iheaa 
ncidN most at onco become so. and it wonld appear that henoofoitb 
, their hiMtory mu^t fultow tliatof thcHAltnthoy form. Yet the raoeind 
notion of tho action of thrse acids on Ibo organM of iho body is w> 
difTiTcnl from that of any of thdr nlt«, that iho bchavionr of tlu> 
nciils most bo spoken of sqwratoly. 

On comlnning witfa thu allcalic* uf tho blood, Iho acids must 
frt« somo wcalcvr acids, and so to a alight extent InMwn the iklka- 
liaity of tlial fluid, aa ia ovidvnctfd by the incroasod acid r««ction of 
the Brina following tbe nao of mineral acids. ^V'hat farther olfifU 
tbny may hare on the blood is at present (|Bit« niiknown. Tliey 
nra rvpnlud to bo tonic and l)racing, bnt the improvement in tlie 
geiwml health may more safely be attribntod to tJteir action on tho 
intoDtinol canal- Slilli tbey do prodnoe oertain ohangw in tl 
fluids and eulids of tlie body, sinou in tbo abssnoo of liao-jnioo i 
I (ratli wgotabloa, adits, napodally vinegar, act oa prewntivua of 
'■DBiry. 

Thu fanctions of the boily are supported only with alkalfno or 
Boatral blood. Slight nciilily is at ouce deatruotiv* of all fonctioii. 



ACIDS. 



181 



■is well seen in exporlmcnts with the detached frog's heart. Wheu 
•ii[)jiltcil with liloiid. or villi niilinu Kilution and n. [ibyxiolo^icnl 
((□aDtity of potosL find lime ^ts, if a eihaII qntiatitj of acid is 
nddvd, eaongh to unuKc thi; fiiintc«t rciiCtion, llii: In-art noon ocfUCH to 
beat spoDtAneoDAl}', and in a little wbilo all cDutrnvtility is lost, the 
TXintriclo mfuKing to oontnuit when Mimalntod by a strong ffintdaii; 
shock. I find that a ventrit-le will beat for hoani when fed by a 
ncntrnl ccilnlion, compocod of cnlino tiolation containing ono ton- 
thoiiuLndlh [lart of potassium chloride uimI a minute dose of ualcinm 
chlnriilc. It in obvious theo, that idkali in tho blood is not itooomury 
for fuiiL-tiou. Bui with eveij performance of funotion octd la formed, 
ecrtainly in tho muKclcB, and noon the nentral Rnid wonid becotno 
acid, when fnnction woold be destroyed. The alkali of tlie blood 
DAQtralizoe the acid and preronl« il« d«pr9fringoffoct on tho tiiwtic-.fi. 

Hyilroc^hlorio acid iii fretjnenlly given in fevere. especially of a 
typhoid ohiimctor, and pho^horic acid in cases of nurvoiu woaknees. 

Dr. Rees recomnicnda lai-go doMi of lime-jnioo to the extent of 
eight ounces daily > in acute rheumatisra. Dr. Inman Njicaka highly of 
this treatment, and obMn'os that neither tartaric, nor rilric acids, 
nor lemon-juice can bo subetitnlod fur limo-jnicc. 

Nitric acid in rDCouimeoded iu SL-condury Hyphiliti. It lias beeu 
said BOmelimcs to induce salivation ; if so, this may havo been duo to 
the direct tkction of Uie ooid on llie muuona mi^rabrane by inereasing 
the alkaline seci-etion of tho talirary glands. 

Acidtf Kvm KUuietimCN to abate tJie mpidily of llio pulxe in feven; 
a retult not dne probably to the direct action of tho acid on the heart 
or MTTvnus contrcK, bot more likely to tin; relief arising from dimin- 
iithed thintt. Sulphuric acid, esjM^i&lly in conjiniutiou with sul[)ljale 
of xinc, cli<%k« tlic^ jirofuiw Kwcating of plitbiKin nnil othor exhuuHting 
diacDsw. Dr. GrftTce ascribed a similar action to vinegar, and often 
vued thi* bvonrito receipt : Dixtilled vinegar J ij. Laurel water 3 ij. 
Syrup 3 vj. Aqua 5 v. An onnco or two ounces to be taken every 
tliird or fourth hour. Sulphuric acid in HuppMcd to chock bleeding 
from tlia lungs or womb. It in diliicnlt, indeed, to understand how 
an ordinary dora of Nnlpbnric ooid can i-xi?rci.-« Kuch an inflnimco 
after becoming so greatly diluted by admixlLiro wiih the bloud, and 
the diiBcnlty in vnhimcod by the comiidcnition that those ncidH, either 
efore or immediately after l^ltcir entrance into the circulation, aro 

Dvvrtwl int« fa,hf^ n» Kulphiiti-K, nitniles, and plioii]>hat<Ti>- What- 
ever induenice, therefore, is exerted on distant organs mnst bo effected 
through these comliinntionK ; yL*t we cannot nvcribc to any Kid Is of 
tliese acids properties similar to those ascribed to the acids them- 
icivrtt. 

In Hucli qucetiona cxpenence is a safer guide tJian speculatiou. 



182 



6CLPHIDX8. 



Tlio siibtle inilneocQof oTen Baiall dowaon distiuit orgniu of the bodj 
U well cxoiDpliricd hy Uui eSoct of llioiio m«dtoin«s ou rJitt uioth«r'a 
milk ; for acidi Ukon for some timo indnce in Uie child Kiuknesc, ' 
diarrlui*, luid culickjr poiiu. 

Pliosphuric fu-id has boeii recommended in diabotrx. Qriocili 
wUo Ihm varvfalljr Mndicd ihv action of litis medicine, <iODsid 
that it don more h&rm tbiw good. He employed tho ncid, to llw 
extent of nn i>um:» <tiii]y, nud fonnd thnt lbi» dow t»crcaM.-<l lb» 
HTiffJir. SiDoe th« momboiv of this ^rt>u|> augment the lunditj of tUo 
urine, it lias bocn proposed to diaaolvo photqihatic cmlouti by i 
ciAllj- acidi^ng tb« nriofl ; bot &8 tbeio acids only slightly aii| 
lh« aeiditf of nrin«,.tho]r most bo tukon for K [■ruloiih'ed iwriod 
bvfbrc tkcy coold tnatonally dimininh tho bulk of a atonv i morvovor, 
lh«r« Rimaiiia the in«nperablu olijoulion lliat Ihisi m«tbod of treating 
cftlciili would serionslj damage the mncooa membrano of (ho Htoiiuurli 
and intutinuN. 

The injectiou of nitric acid, sulBcicntlj diluted, lias been uin|>lo>'e«l 
vilh tnioctait bjr ropw emini-nl onrgconii, and is a far iaon< elTeclnal 
tmatment for pbo«phatic cak-ult. The esperimenta of L>r. ItolirrU, ot 
Mani'liuKtrr, on tho wilvt^nt power of dilnte colotion* of ihia ai'id oo 
calculi, after their removal from the liotlr, luad him to the convictioa 
ibat thin traatfDunt ia wortbjr of nnt^h wider application titan it at 
ptMont obtainB; morvoTer, bjr nentiulitiu;; the uriuc, if alkaline, and 
jirorenting it* docompOMtioo, nitric acid injcctionB protect llio 
mucona nwmbraue of the bladder from tJic irritation of tbo alkaline 
nrinv. 

The further influeiioe of Kulphnrii'. nitnc, and kjdrochlorii! acida 
on tbo nrine in nnknown. Of the inSnunce of acetic and pboaplioric 
acids wu shall ajHAk in aiu>tli<.-r jdacr. 

It libould ))o rsBMBtbered that phonphoric acid niaj jkioscw uiaoy 
otjier pm|)ertiea tlian those already- BpuL-ififol ; bat tlxMw will be ro- 
forrod (o in spokiog of the phosphates, for it ia in Ihis foi-m lltat 
phospfaorio M:id cxisU in the blood, and inanifnKis maoj- of ilJi bains- 
fioial effocU on t)i« diacMed bodj. 



SULPHUROUS ACID. SULPHITKS. HYPOSULPIUTKS. 

SvLrBUBora acid ia a poUmt poison to tho lower forma of life, ami is 
romraonty ami as a deodorixer aod dirinferlnnt. It u a dooduriwr 
bjr virtue of itx jiowoT to anvat pntivfaetion ; heoce it may be garni 
to preront ImJ smelts, bat it pomeasce little ur no puwor to iWoinjiuse 
olaiMve ([asea, and thnvtoro it ia of little wrrioe in deatrojittj; funl 




sc^iLpacBOPs icrD. 



183 






odoon. It amiiit« ferm<<nbttinn bj destTCijtDg the minutfl orgnnisiDR 
which dotermine thi§ process. It disinfecU liv deatrojmg the micro* 
organimna Uiftt propngnto I'ontiigioiiH disuutog. 

It mast be bome in mind that Bulpharous acid corrodes mettvls, so 
that, when ased ud iv diitinfcctniit, thiwo iih(ml<l ho protiH^ted bv m 
covering of some greasy sabstaoue. In ranugaliiiK a room, sufficient 
niphur. abont an onnoo to «ach hundred cubic foot of Hpnve, tbonid 
bo banied to render the tkir unfit for refipimtion, and the eeoape of the 
gas bj the chimnejr, nindovrfi, and crnvioes of the door^, fihould b» 
proreotcd. It is better to repeat this proi^oHn three or four tinit« at 
iutervaUi of twenty-four houn. Ti> dtxinfoct a bed, ilr. Startin re- 
commends thiit a warming-pan containing lire coals sprinkled with 
aulphnr xhould Im put between the chttheN, till the itiilphar in con- 
sotDcd. A damp napkin hold before the mouth will piwent the eul- 
phnroDd acid irritating the Innj^ It ih far better, howc^-cr, tu 

bmit the bedding, drc, which cannot be boiled, for some hours, 
a tempenture between 250' and 3Uif in a disinfeuUng chamber 
or oven. 

Baxter tindn that xolphuroQH acid ts tmm dcatrnctirc of the vaivine 
vims than either chlorine or carbolic acid. 

The ciutokirat way of caring itch in to immorto tbu pntient, leaving 
hie bead free, in a gaseons bath of snlpharnud acid, made by burning 
12 dntcbmH of nuljilmr in n suitabli! apparalns. ^Vhi]st in the bnth, 
the patient's clothes shonld be baked, so that in half an honr ha is 
cored ef his itch, and ■« made free from risk of re-infection. 

The Boid will cnro ohlouamei hy destfojiug tlto pamnto on which 
the diaenao depends^ The acid of the PhAmiacopaeia mixed with an 
equal quantity of glycerine^ may bo used. Warm luithH sheuld 
al«o be employed to r\imoTe the cuticle infest^^l by the parasite. 
It ia useful also in favug, and in tinea tonsanuiii ; bat when thcaa 
aSeclionR arc unnRoally obartinate, its notion should bo assisted by 
epilation. 

Dr. Dcwar, of Kirkaldy, has drawn altcatioo to the I'CDL-ticial 
action of salphntOBs acid in various disoaaes, and many of hut slate- 
menta bare been confirmod by mbBequent ubserrerB. 

Dr. Dewar applies the solphurone acid in three ways, — oh a aolu- 
tion, by fumiKaiion, and by the spray -producer. A solntion of tbo 
acid or tuniigatioo with it, he says, will Fpevdily euro chilblains and 
chapped hand;*. Bqual ])tirta of the acid of the Pharmncoparia, and 
of water or glycerine, will, he states, at once caao the burning, and 
pt«v«nt the spread oE eryaipolas. Wounds and sore nipploa lie 
treata with the Boliition. oonatantJy applied, either neater diluted. 
BmiMiH, be Mtys, may be ]>revenled or quickly removed by the aamo 
treatment. 



IM 



■ iOD. 



Aoconling totlie Bftme authority, nuny interiuil fliscAMs nni oqnnllj 
MBcOiabb to niilpliitrniw acid; amoDgst otlicra, cnid in ttie bead, 
infliinna, tonGittitiH, matipuuit noro tl»ro»t (Mvrlatinnl or otlicnriM)* 
lujrngittH, chruitic bronchi tie, clirouic i)fathiais, aallinui, cro<i)>, der^gy- 
puui'fl housenem, anil typtioid tovm. 

The Oicid mny bo applied to the tbraat hy fumigation or hy inbala- 
tiou : » fovr drops iJiould bo added to boiling water, and the irtMin 
inlialed i or the aoid naj be a)>plied bj a vamet-hftir brash, or by the 
ti{ii'aj'-]>r()d ucer. 

It maj- bo carried into the lunga by fiiini)^tion, inhalatiOD, or by 
Hptuj. If proporlj' and carcfnily omployvd, the Pbarmacopeeift acid 
csvitea ecajxeiy auy itrilatiun or aanoyani-e. The application of nil- 
phuroa* odd nay bo conducted in tli« following wayv : — 

" Pot a few rod ciuderm into a kitoheu shovd, get this upon ■ 
wooden stool, and thoo aprialtlA Bowl^nt of sulphur frum time to timu 
till the room ts not inooureaiently filled with smoko." 

The epny may bo applied by a raporiier now in common ntw, 
farniahed wiih vutcanilc tobos constructed upon Or. Devar's plan. 
For a child the ioitrnmcnt sbonld bo buld aI)out IhrtX! feet from tbr 
mouth, and the Sue spray should be inhaled and the procen re- 
poatod nowrding to drcnmKtanciHL In an acute attadc of diphtheria 
with no time to loee, it may bo repeated hourly, or otod oflener. 

In applying lint f pmy to adutt«. Dr. Dcwiir directs thooponUitr " to 
hold the tuiit\e uf ihu inflnituent about &ix inches from the patient'* 
month, and administer three or four whiff* to liogin with ; Ihrn, after 
a ooneBjioudiu^ interval, during which a cough or tiro is giccn, the 
firaoosfl is repeated, about twenty Mjuceum, in itll, which reprMdntil 
the injection of from forty to sixty nunima of aci<l. The add should 
bo pnnf.'* 

For the relief of rheuniAtiiini and gout, besidca the fumiRatiuD, Dr. 
Uewar advises that the bed-clolhes shonld be ospodeod to the strong 
(UDMM, and tlion aprcad over tlui [latient, who after sweating and 
aleejung wakes much relieved. 

The tolnlion, eitla-r strong or diluted in rariong itroportiooa. 
cpcodily trmoTcs tlirusb. I>r. Lawson speaUia highly of sulphurans 
add aa a rvniedy for pyrosis ; tndce<l, ho tays it never fails to be of 
wrvico, sml iu my ox|>cri«nee it seldoni fails. Ton to fifteen niiiinw 
abonld bo tokvn ten ininntea Iwforo oachmonl. The sulphite Iw finds 

BMICM. 

SnlphuTous ncid in doaoa of 6v<i to ten minims oft«n provent« 
Batulrooo iirodueed liy foRnnitutian, and is uspccially narful wliott 
tlia gM IB abundant. It is more efficient tlian sutphiUi* and bypu< 
Bulphiien. tiulphnrons ncid i* useful as a waah or gargle in iU|»li- 
thvria. 



rasoHic ICIV. 



185 



Stilpli!te«, iKlministored bjr the montb, will, it in cnid, prevent dfl- 
coDipoeitJon tuid pntrofaction of nrise in Uio bladder. 

SDl])hitca luid lijjioralpbiUis b»ve been cmjiloyud to deslm^r Karcinie 
and toraloi in Uis Ktomocb. 

It is said tbat hypusulpliitv <>( suda. in fift«i-n to inxiity groin dosw 
tvorj two hoars "'>I1 *:"ro inttmiutttfiit fuvor, but more ciLrcfnl 
obMrvers do not ccrroborntv tliis etatemvnt. 

It was at one time said tu be useful in the acute specific ievtrrs. 



CHROMIC ACID. 

Chrouic ncid was Rrst Deed as an e^barotic b; Mr. John Xarabnll, 
t^ Cnirersitj' Collugr, who employed it to reroore warty growtba 
from tlia noE*, geiiitnl orgau^, or elsewhere- Immcilintctr nftvr 
touching the pnru with chromic acid, Mr. Mfirahall applies lend 
lotion, " nh'ich rnxtrain^ (lie anbseqnent inflammation, relioitsH Uso 
snbsoqnent soreneiu, aiul dcicn not in any way neutralize or ret&rd tlio 
i«)iid effects of this apparv^utly nseful cwharotii!." Ho um* a ih>]ii- 
tion containing- a hundred gniinn of cryHtallized cliromic avid to an 
ounce of water. " The nolution is best applied by the aid of a 
pointed ),'lasB rod, or when n large i|iiiLntity is needed, by means of a 
small ^'laxji tube, drawn to a point. Only to much should be applied 
as will Ktturattr the diseased growth, avoidioff the siirrtmudinK 
healthy mncons membrane, for, thou);h the nolation in not suflii-icntly 
powerful as an otcharotic to destroy nr even vesicate llie mucouti 
nMrmbrnnc, it may ffive ritiu to an unneceMary amount of inHamma- 
tioa." '* Any xuporflnoos acid may bo removed by a piece of wet 
lint Tho (irat effect of ila application to the warts is to produce a 
■U^t smarting pnin. If, howover, any nlocrated aurface be touched, 
the pain is of a burning choraoter. more tasting, but not so acute and 
intolerable aa tliat caniwd by nitrulo of nilvcr, or by nitric a<:id, with 
or without arsenions acid. Under its inllnenoo, th« morbid growtliK 
ra|>idly wast^t, in some gasm being thrown off altogether, and in 
olfaura nndorguing a partial, thou^-h vviilcot, diminntion in sitie. 
The beat imiaodiato dressing is dry lint, iiftorwnnln the part may Ijo 
waMhed with lead lotion, and dressed with lint moistened in the 
same." " In most casos one application snfEces, the cure being cnm- 
plelvd in from four to ei;{ht days. In Bover« cases, where the warts 
are large, repeated applicationsare neceMorr." Mr.Marahall further 
Ktutet that " chromic acid eolotioo neither bnmH &or stains liaou ; it 
all washes ont." 

A aolatioB »f thia ncid is said to allay itching, but the kind of 
ildung is not nivntioacd. 




Groap embmoiiiK CAUSTIC POTASH, SOLUTION OP POT- 
ASU. CARBONATE AND BICABBONATK OF POTASH. 
ACETATK OF POTASH. CITRATH OF POTASfl, aad Uw 
corroepomding {trepartttioiis of SODA, POTASH SOAP, SODA 
SOAP, BOEAX. 

Tbk membere of thin groap nro rII vnilowud with rery high difTosioii- 
power, tbe potMb inngroaUT degree than tho Boda-mlU. All nn> 
very feeblj soluble in watw. With tho exceptioa of tha »oi'Utca 
nnd citratds of potash or eoda, tliey bare an alknlino roactinn, WMk 
in some, m Uie biborat« of sodiv, bat v<ny marked in otliera, m CKnatio 
potMh or Kodft. 

They d)S!i»lv« the nitrogcnouH couMitnetnU of the nninutl t«xturc« ; 
ami tliinr solvcoit power is in proportioa Ui, yet distinct from, their 
affinity for water. 

Owinff to llirir aflinity for water, and th*ir solrent action on the 
uitrogcnims tisHUCM, sovernl uf tlieno miliiiiancvii, by nlwlnuiting tbn 
conHtilni'iit watiT, will dcntray the skin or othw stractnnM to a pon* 
eidwHble depth, The caagtio atkalim poH«aa a groatfr affinity for 
water, and tlii-r«ror« a more aolrent and do«tructiro Action on the 
tissuaa than the remaining inembun af thix iv'Ti>iip. The carbonnlM and 
Holntion« of thv (-Anatic alkaliru oomv next ; while the bicarbonate^ 
a<H-tAt«a, and the rfuit of this groU[>, arc comimnitivoly fceblo agvnti. 

The cauBtic alkiilieH, nndilnted, or «omotima« mixed willi caitstla 
Itmeto leaaen iht-ir ot-tirity, are oftva enplo^'wl to dentroy wartr 
growthii or tba hard odgea of some vnhoaling sotm, anuh aa cIiaiM.TnH, 
or to open abcemeo, or to make iunee. 

It tnuBt bo btvnto in mind that, in oommon with tho rest of Ihia 
gronp, the i;aufltio nIkntiMi, poweiecinf; a ver\' high diSnKion-)>owor, 
will penetrate the tisBueaand destroy th«^ widdy and dwply ; unlcM 
gmat eve IB taktni, th« nnduti diffusion of the alkidi will dcRtniy a 
far larger amonnt of strtKituro than is intcnUod, prodncing n lar|[a 
•tough, and ttnving, of oottrms a cnrrospoiidingly large mrc Tbft 
■ppKoatJoQ of tho alkali almnM alwara bo checkod before it has taken 
fall tiffeel, ainoa the dMtraetJn effect will i-onlinnn for aomo honra ; 
other pmcaationa should likewise bo obsem-d, or tlio vauatic alkali 
dissoWmt in the 6nidji of tli« tiMBe« wilt mn over a largo an rfaoo. 
mbdoquontty deatntying it. In making an iasne, piDeos uf ]>Ia«t4a-, 
with a hulo in (hem of tho required siio, Rtunld bu plaoed ono uvar 
the other, anil the oauntio applirtl to Uie skin cxpoaed tlirosgh tlio 
hole, while the neighboimBg parta aro rffoctuiitly prolvct4'd. As aeon 
as the application is fiiiishud, it U dwirable to wn&h tlio surfaoa 



I 
I 



I 



ALKAUES. 



187 




^tio: 



ith Tia«gni- and water, to ucntmlt»3 luiy retaai&inj; alkali. TUo 
ic, very elighlly moistened, Bhonld bo rabhcd on tin) HurfuLS) 
it aasDiue!! a dull bluuib look, nnd till tbo cuiiule in Hofteueil and 
oMiljr mbs off, whtm the applicalion of a ponltico will Iiolp tho 
tteptmtion of tb£ dead i>arttf, and votu: the paiu. 

A solntion of a TDcmlrar of this groap spongT'd oror tho pcocwnt 
part will often allay tbu truubltuome iti;litR^ uccompiinyiu^ many 
«k)n diiM!mi»i. A weak eotntion of tbo caastic salt, or of its c«i'l>onato 
best, A wliition of corboDiite of potu«h or xodn, cuntaioinf,' a 
lAroobm of the salt to a pint of water, applied with a amall pieoe of 
', is often of extreme comfort tu nrticnria or lii^lieu. A wnltiUoti 
HunostrDngtb.of eyanideof potaasium, wkich has also a Htrong 
alioo rcikctitm, In, porbajHt, n still more elTeulive appticntiun. 
Tbe itching of many other eruptions, ea of scabies, eoiemfti proritns 
ani, and pruritna tdIvu!, luid prurigo from Uce, yield mors readily t<> 
Other applications, wtiit-h aro indicated elsswhare. 

The carbonate* of the alkaliea are employed in the treatment of 
cithsr soap, or in the form of ointment, to remove the SDporfieJal 
>nd dead cnticlir, and so to break up the burrowH of tlis itt-h insout. 

By virtue of the alkali it c-ontnins, soap facilitates tha romova) of 
tbo scaled of ptoriosis. 

In the treatmont of ocsoma, a muik solution of carbonate of potash 
ir of Roda llnda mnclt favonr. I have no doubt of itfl usofnIiuMK in 
the Mrly and middle stages of tho disease, wheu the led and raw 
anrHaOtt weep* copiouHly ; but wlicrn tlio wnsping has (■enoed, and ecpv* 
daily when metv desquamation remains, tho alkali fails to bo tit use, 
aad other applications are prefctalilo. Dr. llogbea Bennett rvoom- 
mCDds a solation containing half a drachm of <'arbonate of sudu to a 
pint of water, and tho affected surface ti> lie kc|it cinAtantly moist by 
a thin piece of lint, «oaked in the aolntion and oovercd Mith uilakia, 
or with a piece of lint spread with simple oinlmont. A weaker solu. 
m acta aometimos slill better. Like the oiUkiii, the ointment 
proTODta eniporation, but is less " hoatiiig " and is ruoro comforlaUs 
to Uie patient. ThiK treatment is an instance <if the general prupo* 
(et(/« spcUon on the topical action of alkalies and acids on the 
tionii) of alkalicK a» local n]}plicutJonK, chri-king an alkalino sooi^^ 
ion; for tho llaid which oosm so nbaudantly f rom fK-idmatoaa aur- 
L1I is stTDDgly alkaline, and on alkaline application very speedily 
liccks tlie abundant weeping. 

must bo admitted, however, in some instances, that an alkali 
to irritate the skin, a result often due to an over-strong 
lolotion. Dnring this treatment attention must bo paid to tho 
•tate ef iha digoslire orj^aoH, and any irritation produced by teething; 
ynmoB shoald be attended to. 



othoi 

■ti 




188 



1LULU3. 



It ts eoDMtimes lueful to wash Out raoist md wcoping oczctnatoiiB 
Htirfiuw niglit and momiDg with Kup and water, wliiuh id uutn/ i-uc* 
L-bucks the Biwretioa, und allafs ttio brai and irritation. If n Btroog 
KCAp w too irritating, n milder oae mnHt be uaed. In i-lironic foraui 
of ec^ienia, Hcbra rwommands the apjilinttion of liqnor pntafaoc, nr 
of tfaft BtroDger Bulntion of catistit-- imtaab. He ndvi.iLii tlint liijuor 
IMtaww Khonld bu broithvd oucc a daj over tbe sarfaoo, and if it pix>- 
ducos tiiDt'h BDiariiDK, the r«ii)diu! mnitt bii waabcd oil with oold 
water. Wbcn tlio nkin in on); slightly iutiltrated and thickvoed, b* 
vmplojTR a solution comitosed of two gmina of canatii- [Mtonh to an 
oiUKyi of water; biit wIkid tbo inliltTation is greator bo usee asolat^oa 
Gontnining from fire to lliirty grainx or more to tbe ounce. Tbeae 
atrongcr upplicntioiu matt be employed ooly onc« a day, and mnat be 
qaickly waahed oil witb oold water. Thia treatment Hpeedily alUya 
ilcbing, but is liablo to make tbe skin britUe, and to obviate this 
4-onditiou, Dr. ilcCall Andorvon applies cv«rj niglit either <!od> 
lirar oil or glycerine. Dr. Anderson frequently employs nikalica ia 
oonjunL-tlou with tar or oil of cade. Ue reoommends the following 
prescription : — " Kqtial paris of E«ft eottp, rectiBad spirit, and oil of 
cade. A little of this to lie lirmly mbbod over the ernptton night 
and morning and washed off before each ro- application." Mr- 
tiiartin oondeinnN tlm nm of soap in rcxonw, or in any ulcin diuvM^ 
D»inp inmciid a wash oonsisling either of yolk of egg and water, or 
aiiJk and water. 

Sponging the head sereral times a day with s eatuTated solution of 
borax and water i» an effcctnul application in ])ityriai<ift of the ncalp ; 
it nt onoo onsos the ilcbing, loosens the scales, and cleans the head. 
PilyriuHin oftun Kii*"< way in akhort time to thiK trMtmunl ; althongh, 
tmfortnnately, after a variable period the affection generally returns, 
which indeed hnppenn wlicn tbe diaeiue is removed by other tn<aU 
ment. Should the ]>ityria(iis prove rebellious glycerine of borax often 
IxnTiw more useful, a* it keeps the scalp oontinnally motat witli tbo 
weak alkaline prejiaration. lliis plan is useful, loo, in ocicnu of the 
ears ami sL-nld, 

Aonc panotala K«Der»lly yiel<ls to bot water and |>leDty of soap 
•ovetnl times a day, a tmtmvnt which keeps open the orifiooa of 
lbs ssbaoeoKB fuUioles and proreuta the accumulation of the abowlaiit 
Moretion. If this treatment roughens, reddeni. and irritates the ildlit 
it ebonld bo well rubbed with ^ycerine of btsrch after oaoh waahia^. 

Free ablation with soap and water is very effective in deeoni|ioriag 
and removing the acid irritating N(<crelionH which keep up the inter. 
Irigo so often infesting tl>o bntlocks of childrvn, or in the irrita- 
tion in the fold* of the «kincfBlout(-liililr>.ii or underneath tliebnusis 
of fat women. After carefully drying the parts, they dunthl 



I 



I 



ALKALIEfe'. 



189 



vrUI< 



smeared over with somo greaAj apgilimtion, wliioU Ih fr^nerally pre- 
f«ntbl« to doKtitt^ poirders, iw stArch pow<lcr or oxide of sine CAOstic 
potaali or soda ih oonkatinuHt nsed to open abMcusei with the intontion 
of pro muting scarring. 

Alknlinu hnthn arc nftcn cniplnj't.-d, but their action oa thi) iikin 

d ite secretion in not vet anltsfoctorily determined ; Iik« acid or 
aimplii bath* ihey liiiwcn the acidity of thu urino. 

Soap with exL-ess of alkali will induce jjityriaeis of the face, which 
will often difiappcar ttl once on snbHtilutin^ (iiitnioid or ii milder soup, 

*■ Compreeeed gljcerino soap " or " Solidified glycerine." 

Mr. Poppercorae rttcommc-nds a KUturated Milulioo of unrboniito of 
ofl a looal application to bnms and scalds. 

A nf«k eolntion of bionrhcmato of pottutli or soda, a drachm of the 
salt to a pint of waiur, ia a useful injei^on to check loucorrhoea, 
wh«n this dischnrgo dopondd on na increased aecretion of iho glnndN 
of the oa ut«ri. Tlie Hecretion is strongly alkaline, and when trndaly 
sbondant, tho oflicacy of thi> atkiiline injection in snch oaao in 
uiotli«r proof of tliu general pi-ojiosition that alkalies ohock nlkalino 
svcretions. 

Wlien the leucorrhcea! discharge is clear like whito of egg, or 
'iun it ts Intnpy, but not yellow, tbrue or four injcctionii will 
check it. On the other hand, when the diechtvrge is yel. 
ow ond pnriform, the injection may fail; although in many cnHun, 
when this yellow dtNcliargB is doe to more abrasion of tho os uteri, 
the injection, continued for one or two weekx, will change the yel- 
low to a white dischargo, aod tomctimca crubo even this to disap- 
pear. If tho Ieuc!orrbcea is produced by diHplnccmrnt of the utcma, 
or nlceration of its neck, this injection, like many others, may tempo- 
rarily chock the diHcliarge ; but it soon rutnrnH, and in «iich cases tho 
lenoorrboea cannot bocnred till those conditions are reiuoTed. 

Tha sncooM of thia injection obvioualy dopvndii on it* roaohing, unci 
ooDiiD^ well in contact with, the as ntori, tho offending part; heneo 
it is noooasaiy to givo full and careful dirt-'Ctiimii a.* to il« use. The 
patient should be direot«d to lio on hei' buck, to raise tho buttocks by 
placing a pillow under them, and then to introduce tho nyringo ns far 
iiK nhu conveniently can, and to leave tho injoction in the va^na 
nlxjut live minnli-j>. Tlie injection should be nsod cold, when it mu 
be lmm<', twioe or throe times in tbo day. A Kennedy's syringe, by 
means of which any quantity of lotion may bo forcibly injiwtcd, and 
wliich, by washing away tho diiiohai^DS and douching tho part witli 
a cold or wami im-dicatod application, ifl even moro effectual. 

Mr. Xorlou. of St. Mary's Uospital, ingoninusly employs a solution 
of liquor potasMo (two drncbnis to the ount-e of water) in tho tnal- 
mont of ingrowing toe-nail. "A piax of cutton-wool is saturalod 




190 



ALUUIE. 



writh Htfi Kolntion, nnt] pntMcJ jtently (lowti bctwDvn tho uppcir mr- 
facL- of tliu oail anA llic soft tisBam. Tho eolntion penncatoa the 
■Hlbstanoe of tlio tutit, nnil woftciu and pulpeUtes tln^ Hnpirriii-iiLl colls. 
I'lio wool in kiipt eontiiautly moist nith tbo lotion, aail mfteBnt 
tiMuoB nro wiped away CAch momins. Tho nail in n few dftjra be> 
rome* tliin and flexible, and, if d«siivd, it can be pared awftj- with* 
ont p)un. Tho lotion fthonld be continapd until all nlcnrntion has 
dinppMrcd. 

Bomx is luitiwptic, and pivvents fermontntion and pntrctnotion. 
It oiK^nihitos yesst., kud destroys its pown* to dcrompoee hd;]^ into 
nloobol. It dsitroTK the avtion of diuitaw) or amjgitalcn, and bo pro* 
T«Dt« the fonxuttion of oaMnoo of bitter almonda aod pnume noid. and 
tlM convDnion nf Ktarch into kIiicow. It alim dostrojii tha lUtlioo of 
uynMJtio, and prevents th^ formation of the ]>uiigeDt eaaeoo* of 
RHiBtntd bom tho mnKtnrd fariiia. Bonuno acid poMOmos tha same 
]>r>pnrtic«; thej tJias aot like other aotbeptioB, as qainia, Ac. 
Uoracic arid w not now Ui^uly DKfd, oithnr an an ointownt or loUon, 
or n dniKHin^ for liam<t and wounds, A teaMpoosful of bontrio acid 
di<«nlrc(l in n pint of Ixiiling water, and nscd tepid or cold, ia my 
usxtfnl in pruritne pndcndi and in eoxoma of tho vulnBi 

Tho lata Dr. Simpann. of Uiyb(iat«i, told nui tiiat bonicto aciil dta- 
Holvcd in fi'T'^Brinc isa very nsoful local applicjttioD in dtpht]u>rin- In 
n hHtrr to mc, \w my*. : — " Purint; tlii- liutt cpidi<into of diplitlieria, I 
hare xtmi boncicnoid dissnlvcd in pljccrine (in a watiir balli) of tha 
atren^h of 1 id .10, appli^id liy nuttna of a hmah to the thro*t, 
tnmrf two hoara day and night, until all trace* of mcmbrano had 
disai>paa<ad. Tho piilihim took on n wbtt« colonr, with noolfmuite 
odonr etnanating't and in the ooutui' piobably of forty-oight hours, 
and often much oartior. do tram of membmno waa viaiblo. Dr. 
Cl»a*rEwarl end I foand by ej]>entiietit thnt bactoria itmmt ht 
1ht> niMnbrane «> treated oonld not b« propagatml. Children do not 
didiko the tiuit«. I llnd bomoio acid, of ativngth of 1 in 50, of smv 
vioa also in utoniBlilia." 

Sir J. Siropion recommended bornx id "the |irarigiaoM ortip- 
tiiiD which nppcan on tJio m»coaa mamhtane of tbv rnlvs, and «k> 
tcndx np along tfao va^na as far n* tlio ocrvix uteri. It tnnj' ahia 
ntcnd. am) ia aomotiiDM, indi-od, nri^'innlly gitaat<<d on, tbo I'Dlwa- 
rona linrdvr of tbo vulva, and ap]MiaiM on tho oiit<rr catanoomi 
Norfnuo of tho labinin, apraadinf; IxMrku-ardii alonif tlie pKrinantm 
to the circle of tho anas. Aooordingljr it ■■ a Hitting and tranaiaat 
aHliction, raonrriB^ with menairnniion, prcgnaooy, or dallvory. It 
mny be mora Bsed, end laci wevkn, or numthM, or yenra, producing 
con»tnnt irritation and dislrvaa, fre^nratljr inl^rferinf; with iwal mhI 
sW]*, and rendering the victim* miHorablo and almost detailed whaa 



I 



1I.XJIUK8. 191 

the diMA«e has become BOin«irh»t chronic, and nooMtitatM Ous 
[iBlii-iit to BlU!ni[>t to allcvirito it by nomtant ami somotioiM rough 
friotion. The mucous m«ubrane becomes at tbu miixt irritsblo parts 
wliitv, and thiok^ned with nd firanrM." This distroaaing complaint, 
aajB Sir J. Simpion, " mny be F^encrallj cured by tho ii«idtiotu and 
|x>m-Tcring application of a solution of biborate of «otU (6rc or t«a 
graimi to tlio ounce of wator)." A hot icolution mnch ciihaiic«B tbe 
effiicacy of borax. Wat«r alone, bs hot as can be fairly lK>ni(.-, will 
oft«u allay thi« itdhJn^; Imt hot water with Inras is far more 
eBteactouB. If this trmtmont fail, infusion of tobatx-o mny Iw tried; 
or au ointment of iodidu of loeul (J i. to J i.), or of bivmiith and 
morphia. Chloroform vapour, linimont, or mutmout, in often found 
tuwfnl ; a drauhm of chloroform may be added to an oancn of somo 
sadativo llninwnt or ointment. A stiying l«ad lotion or n lolution of 
Ditnto of biirvr oftun does good. Ur. Simpxon k.-ivh, "There in a 
gnat advantage in attermting tliMo local applicatiooH ; for meet of 
them begin to kae their effects when |>emTered in above a few dayw. 
In tlie nort obstinate and sovere casea strong aatringenta are aome- 
timoa of the gnateet nee, aa a wtron^ eolntton of alnra or tannin." 

Dr. Garrod eiii]>loys stroiifr lolutiooH of lithia mitx to remove 
gontj enlargements. Qoat-Ktoooa are composed of nratos. Vnte 
of lithia being the most aolnble of nrio add aalta, a stroni; Mrilniion 
of a lithia rait ia applied with the intention of converting the nraloH 
in the Ubcrioii into ante of lithia, and ho to soiik tbo uratve oot 
tbroagb tbo skin. Tito swrlliog must ho coniitiuitJy enveloped in 
lint or tag kept moiat with the litliin eolation. In Dr. Garrod's 
practice thia treatment lias proved very roccewtol. fie tliiuka that 
lithia ealta formed witJi the uric a«i(l pnwcK into the blood, nnd that 
in this way gont-stonce ore reduced. He emplovK oarbonato of lithia, 
ive gmin* to the ounce, with which bo has removed comndemble 
enlargements and restored snpplenesa and erea free movement to 
stiff and uaotess jmata. I atno luive employed this trealmfnt with 
ooneidetmble mcoeea. It is es]>eciany UHcful wltcn tho skin is broken 
OT*r tlw goffltj enlargement. Il is well known lliat a aoro of this 
kind ifl exiremdy difficult to heal. Tho oniK^g lieing intimately 
mixed with the oonni-cli\-e tiMUi', and ooxing very slowly through the 
wound, are dissolved and waiihod away by the lithia solution, thus 
enabling the sore to bval. The citratv of lithia is to bo praforred ; 
bnt a strong solution of citrate of potash is nearly, if not i^uitc, aa 
iMofnL It probably converts the biuratea into neutral utnles, and 
in tbia more soluble form tho nrates are carried oif throagh the skin. 
Bqnal partaof eitnte of potash and water may bo ttitod. Neither 

I the aotntion of citrate of litbiii, nor that of citrate of potash, 
firilates the akin. Aa might be expected, this troatment takes many 



weckH, or eren tnonUu, to cScot ooiuidenbl« rednctJoii of Urge 

<IO[IOBit8. 

Borax nni lioney, or tiio glyccriutt of bamx, ia often ntted in 
nphthv. In aphthir tbo mDcous membniiie U uaualljr covered vritli 
fliaall, rouiul, nliurplr-cut xupcrficiAl nlotirn, cov«rod with a pal- 
taceous exudation. Apbthn naturally raas a short coant, and vrbon 
left nntreated ftei» well in ino«t coms in a weok or ten day*. Uta 
(tamo preparations aro luofnl Id removing tbc curdy exudation of 
Ihrunli. 

Dr. Corson finds, that a piooe of borax the siie of a pea, djioolved 
{n the moaLit, >ot« magioAlly in restoring the Toiuv, in coses of snddm 
hoaraeneas brongfat on by a oold, and, froqnontly, for an hour or no, 
it tvndcTM the voice " nilrviy and clear." 

Bonuc is useful in IwarsoaoH oommon among clutffynuin and 
aiQgvra. 

The aotlon of the membom of this gronp ou tlio stomaoh wai 
Bonuiwhnt anlioipateil wbun it was shown tlisl alkalies inercase tbo 
secretions of the giuttric juice, and nuiy thns prove naefnt to pron»te 
dif^atioa. It ia obvious, howovi>r. that method musi be ob>erve«l, or 
th« contrary nlTeet to that intended will eoiitte; for. if given soon 
after a meal, the nlhalies will noutraliie the acid of the gastric jnire, 
and cffoctuidljr retard iiud impede- digestion. Alknlica inl«ndod to 
increoM the qoantily of gastric jnice, and to promote digoation, must 
bo takoD n short time before a mw). Thn alkaline uliva swallowed 
at the beginning of a m«ial is highly useful ; altliuugli, as it tnuit 
spc«dily become ncutralixeil by tbo uciiU of the Ktomach, its notion 
maal lie but temporary. Alkalim may bo ns«fully administiired in 
many forms of abmio dyapejiaia, and in other forms oeaociiiKMl miih 
deKdent secretion of tbo gastric jnicc. 1'ho bioarboaato of sudn is 
the mlt generally employed. 

Wbco, on the otlior hand, a pationt oomjdains of hmrtbiim and 
acid eructotioiM, thfue disagreealde symptonu may at once Iw rs. 
laoTud by Ibe ftxhibition of an alkali, as the hicaihounto. which 
Mmtnliios tlio excsas of acid in the stoinacli ; but it iniL-.t odways be 
remonibervl that this tnattnont is merely palliative. No dnnht a 
4!aar»e of alkaliuo trntmont appenra siimotiiiieB to rvmovo aciility [ 
but the good attributed to alkalies may witli groat probability ha 
ascribed to the toniu with nhieb tlieyare genurall/ Domhinod. 1*be 
bicarbonatos ure prefdrrtsl to the more oanstio aalU on ooconnt of 
their milder aiKion, while the acetaten and eilratea aro neutral, W- 
eomiiig alkaliiw only by d«coiO])oetUoii in Iho fnloatinos or blood. 
Tha bicarbonatea being milder can Im ooDtinoed longer tiian the mttv 
cMiatio pre|MratJoas ; bat tboy have tlw diandranti^p* of giviuff off 
nnck cvbonic acid irna, which may caoM tronUe bom dittensioB at 



I 



ALKALIES. 193 

the stomach. To prevent this, magnesia, which is an alkali, and acts 
like the membei's of this gronp,- may be substitnted if the bowels are 
confined, or lime-water if they are relaxed. 

Alkalies are apparently sedative to the stomach, at least they often 
relieve the pain of this organ. Liquor potassie is generally employed 
in snch cases. 

In cases of poisoning by any of the acids, alkalies the least irritat- 
ing to the stomach are employed to neutralize and to prevent the 
further action of the acid on the tissues. 

In poisoning by metallic salts and alkaloids, the same salts, namely, 
the bicarbonates of the alkalies, may be nsed, to precipitate the in- 
Bolnblo oxide of the metal or of alkaloids. Magnesia, as it acts as a 
slight purgative, and so helps to expel the poison from the intestinal 
canal, is generally preferred. 

By Tirteo of their diffusion -power, the Bubstances contained in this 
group pass so readily into the blood, that but a small portion of them 
reaches far into the small intestines. Little is known of their action 
on the small intestines, and on the organs which poor their secretion 
into them ; yet it seems probable that those secretions having an 
alkaline reaction may bo affected in a double and opposite way, 
according to the period of administering these drugs. The secretion 
from the intestinal glands is alkaline ; hence, if the general proposi- 
tion elsewhere formulated be valid, acids applied to the grifices of the 
ducts should augment their secretion, while alkalies should have the 
contrary efEect. But we have seen that alkalies, given before meals, 
increase the secretion of tlio acid gastric juice, and thus augment 
tlie acidity of the intestinal canal ; they shoald likewise increase the 
biliary and pancreatic secretion. On the other hand, if given after a 
meal, alkalies neutralize the acid in the stomach, and should lessen 
the secretion from the liver and pancreas. On these points, however, 
nothing is known with certainty, the foregoing statements being 
merely conjectural. 

Rutherford, from his experiments, concludes that bicarbonate of 
soda injected into the duodennm of fasting dogs "has scarcely any 
effect on the secretion of bile." 

The milder alkalies, as bicarbonates of potash, soda, or magnesia 
may be used with great benefit in diarrhcoa, caused by excess of acid 
in the intestines. By neutralizing the excess of acid, these snb- 
stances arrest the diarrhoea. 

Soap is often added to anal injections, to suspend castor-oil or 
turpentine. Soap itself, moreover, may be used as a mild and safe 
purgative. A piece the size of the thumb, covered with castor-oil 
or merely wetted with water, and thrust up the rectum as high as 
tbo finger will carry it, in a short time will produce an easy, copioue, 





1»i 



ALEALIK3. 



mnA luttarnl svfKmfttifln. Thig plim b cupcoiBlly avaikblo for Infante 
ami children. 

On ontortBg llio blood, olkalii^H nn<l«r]eo vitrinuK cbnnii^es, noconUnp 
to their compositioo. Tbe stcetate or citralo. nbich has not almdy 
tudci^ne n litn clumgo in the intMtinca. becomoa conwrtod lato 
tile ciirboDat«t the form probably nItimAtely asanmed by ibe oxid« of 

tlw altEBltM. 

l"bo alkalinity of the blood mnet lh«>n>foTt< bo iocroasFil by tbosn 
itlkuliL-M, not [inibably to any gnvt vsl^ml, im from llM'ir bisb (lif* 
fnaion-power th«y arc rapidly oliminatod by tli« kidtivys. Tlivro has 
bun mucb Kpccnial ion 11(1 nci'minii; ItiiK innruifo in tbv alkalinity 4)f 
t]l0 blood. Tbe allialice an- known to promote oxidntton, wbenoe it 
hoi been conj«utur«d that ibt osiilatiou, nixl tluit of tho tixiiacK may 
be incroiis^ by increasinff tho alkalinity of the blood. It has bwB 
s»^c«tod that nlkalicK might bo profitably employt^ in <iinbvtoa to 
pronoto tlie oxidation of the snprar. Alkalic§ have bt>en ndvo>.'«ted 
also for exoon of tino acid in tli» nrini.', witb the oxp<«latian of 
oxidixinff this prodact of tlio nitrogenons tiaanca, and so <;onvfirlUi^ ii 
into nn»a or fotae other snliKtoDeo. Alknlios lura eomotiinuH jpvna to 
fat people to increaae oxidation, in order to connniw the siiper6ttons 
tatt and M to control unMomly obeeity. Tho oolnlions of tbn bioar- 
bonatcfi, and mtpecially of tbv oxiibtn, luv occaaionally, and I should 
tbink niiaDcoessfnlly, nscd for this ]>Qrposc. 

The action of ntkalint in diabetes appoara to bo nil, or lathsr. it 
sbonli] bo aaid, lliey in no dogrM Itesen the amount of ^ni^ aopwatod 
by llic kiilnovK, ntthong'h, if long {)cni)ite<l in, nome di^tngcmrat of 
the Ktomach most occur, with diminnlion in appetite, so that loM food 
bvini; taken, lou imgnr i* rxcrvtcal. 

Mor dona it appear that alkali<>a can oiidixe nrio acid in tJie 
blond; at l<«ut thoro ara no ex]ierimcntn in proof of ihiji. Il la, 
hoirarcr, very ntcfnl to give alknlioa. ao aa to render tho urine 
wmkly acid, or even alkaliim, m> iw to convert tbe Oxoomito qnnntity 
of nrio acid into a more soluble urate. Thia tre*tinont, too, will pro- 
vpnt tlie gnwtb of nrio acid caloult. 

Mi<:tHrition in young malo children not nnfrergiivntlj caana 
nroro pain, traced to the cxUleni-o nf nrio acid or binrnlon, m tbr 
form of epicular cryvtola, which in ibeir paccftgo irritate tbn nreihm. 
By alkalininins tlu nrine, tbemi oryatala are disanlved anal rendoml 
innoomnu. The citmtea harin;; very litllir action on the mnoom 
narabnineol tlkcatonuicbM* UHtHOlIn brut ndA]ili.-<) to dcncidiw or 
daalkalixo tho iinn*. 

Aa to tho {Kiwer of alkoliee to lnorc«M< tbe oxidation of tnim, tk 
ia cinar that iho lonf^-continned administration of the room nlknltne 
|iW|i>wtfoni will tadnco macb WMting of tbe Indy, and ulmita of do 



ILEA UBS. 



195 



dontrt, tmt this in effected bj tbe diaardering action on tlie mucnus 
inembruie of tho stomnich. 

To diminish ffttiuutN in a way m likely to damage IimIIIi, and 
«rentoc>nilangorlife,i8Enrcl;r smigtako. Sotnc writorH of nntlmrity 
iantA. tlutt oinuuly maj be thus ittdoood without any ill cflects on the 
mncons coat of tho stomach ; Dr. N«t^n statcK that ho ium oftoit 
temorod ma uiuxunfortable exoaas of Est b; the nue of liquor potftSSK, 
witbont in any way injoring Hm patient's goiund health. Tlunigh 
oooasionslly suocesaf ul, this treatineat f(«nerallj fails signally. 

Aftor tho paasago of alkalies into tho hlood, and their conTorsion 
Into cnrbonat<v the action of tbesesnbataaomon that fluid ia at present 
bat littte known. T)r. Oarrod i» of opinion tliat aettrvy in <lno to 
deficianoy of potasli nalta with the food, a Bnrmise Buppoiii^l by many 
facts, but not yut confipmcd by ciuict obncrvation. 

The hicarbcHiate or citrate of poiaeh iu ohvn omployod in rlwa- 
matisia. Thisdisciuw insnppoHud Ut bo produocd by an fixoesdve 
formation of Inctic acid, which, having an affinity for oortain ttssnes 
of the body, oxcitos in them the rhenmiilic iullauimation. AUodioa 
ore itiven to nentralise this acid, and to prot«cl tiu> tiiwaos from ita 
action. But so liltlo in known about the nature of rhcnmatism, 
tliat it is impoasible to approach the qneetion of its treatment on 
the theorotical aido. A» careful and exact obierrations of this 
treatnunt are nan>esiatent wo can only bo tnHitonced by iiuUridual 
imprenion. This much, however, mnat be c-onoudod, that in nuiny 
cases rhonmatic pain is much reliovod as soon as the patient is well 
under the action of an alkali and tho nriuo haa ucaKcd to bo acid. 

Many croinont anthontios are firmly cnnvinced that the alkaline 

tivatment rendcn rheumatic fever both milder and sliorter, and 

diminishes tho danger of heart complicJitintuL I have made many 

careful obMtrt-ations on this questioD, nnil am led to bi.<liove that, 

dne attention being paid to tho i^ of the pativnt, and io tlic nature 

of the rhonmatiRni, it will be (onod that these wits luv unavttiliti;r 

either to lessen the intensity or the duration of tho fever. 

I In the fifly.socond volnmo of the Medieo-OhimrguMl TrautMUm*, 

Dn. Gull and Sutton pabliabod a paper on tlie valtie of remedies in 

rhvnmatic fovor. TIte cases quoted, although nnt numorons enough 

I to settle this much-Toxml question, lead thorn to tho ronetnuon that 

I ftlktdies, leraon-juiou, or blUtcrin;:;, do not ahorten tho coune of 

I rlMnmatio fever, but it is not denied that these rcue^cs may allay 

I pain. They fnrtkor conclude that neither alkalies leinon>jnico, 

I Ditrato of potash, nor blisters, prevent the oocumnico of heart dia- 

I oaae in rluinmntic fever. In dealing with Ktaliiclic:* rcUting to tho 

j treatment of rheumatism it is neocssary to bo specially oantiona; 

^^ IIm prtscnt tendency, warranted by obaemtion, leada to the oon< 



US 



ILKiLtU, 



rioihm tb&t hereafter rtutmnatism will be discriminated ioto man; 
varieties. Alrcodj^ wo huvc iIiBtiiicUv« rbenmatla (erem, doe not 
ontj to ireatb«r influenuc, liat to ej^ilis, loMt, &-c., and it is often 
dilBcall, iintl nt fint vvou impossiblf, to dintin^Ub gODorrhocal 
rbenmalism nnd acute fel>nl« rbmimBtoid arthritis from rfacnmatje 
fev«r. tn rlienDiKti^m there i« a largQ nntrorkrd BiJd i>f iii()Qirj-. 

TliL- inRuunoo of hko too ■>■ acnto rbemnattBrn mufit btr tnkcn into 
ocoonnl, Tims in cliitdrcn tfao attack is fihorp luid nliori, d«cUainfr 
UTon wben unlnatod in from 6v« (o t«n daya; and, whilst ifao 
danger to the h«art is much greater tluui with adnltc, t)u) JaidI 
nff(>ctioii in aa sliuitit tliat in an nvnta attoulc, with a temperaliira 
varying Iwtvcon 1(K1 and liH. the ohiid may not oven compUin of 
joint-paiu, or coniphuii *o *lightly thai the nature of the caw may 
easily be overlooked. 

Fever in n i:hilil, with cren the Nlightent pains in the jotiiU. lewU 
US to investigate cnrvfnlly if wo have not to deal witli an ntlncVvf 
acute rhenmatism. On the other hand, in middle^ged and old 
peopli', iilight fuTcr is gcnt-rally accompanied by Mveni pain in 
inaiiy joints, whilst the daaifcr to the heart is almost til, and ihm 
attack iM oflvn chronic. Agnin, the fnttdity of rhcoutnliiim it muoh 
influenond by nsy. Kheumatic hyperpyrexia, the most comtDon 
enuM of dontb in acnto rfacumatisnt, rnmly occurs in chitdrmi nr io 
Riiddli^ngcd pvaph\ Children rvnly die of ncmte rhcamntism— 
iodoed, I liaro never *e«u a child die of this diseaM. The (ut«- 
gomg obecrvattens make it obvioos that, in t»stia^ tlte elKcaojr nf 
mtncdieM, we rauM take <-nre not only to discriminDtr nnx Idiu) of 
rhenmatism from another, but to omparo cases oocurring in iwraooa 
of much the same ago. 

The frcqncncy of rclapeo in avote rkcnmatism ia well nooftnUed. 
1 Ixilivvu this n9la|Mte in in many case* nxplicabla and avoidable. 
Tlina I Imro found that wlien the t4-ni|ii-ratiirc has liooome nnarif 
normal, rising only to CO'A, to 100, or a little over, titere may fan nu 
)»in. ospecially in the case of a child, and the patient feels ao well 
that he b ufteu allowed to get up ami ^valk alfonU ut the gn-nl risk 
of Itringing bock Oio fever nml joint-]nin. In tliu wnnl 1 have fre. 
ijurntly veriflod the fact, tluil relapsM are often brongbt nlNnil itt this 
way, aiMl 1 am sura it is mnoh safer to tuko caro that the tvtnpetatnre 
sluniM become normal, and raraain so for Hovtml days, before tlia 
pBlionl is altuwed to gel np. These cases will tllimlralii the itnp(ir> 
tanceof the tbennonielcr, as m alight a degrer of forer is i|nile 
Undeleotablo by the liand. But Iho temjwmlnro mnsi In laknB 
Hwverul tiuMis a day, as the |>n>t«nutliiral rise may lost only ft fvW 
lutura daily. Kluveinent of the joints in rhntimalic fvrer iaflams* 
ihnm and beJghtona the feYeri if a joint, tnt from infhmiHBtipn Rial 



ALKALIES. 197 

pain, is worked by the hand for a short tirae, it often becomes in & 
few hours acntely painfal and red. Again, it is well known that the 
jonrncj to the hospital often excites inflammation in patients' joints 
and heightens the fever, so that simple rest during tlic few first 
dars in the ward almost always canscs a diminnlion of pain and 
fever. 

Potash salts exist abundantly io the milk, whence it has been 
suggested that the administration of these salts may promote this 
secrctiou. 

The sustained administration of the alkalies and their carbonates 
renders the blood, it is said, poorer in solids and in red corpnscles, 
and impairs the nutrition of the body. These results are probably 
duo to disordered digestion, produced by the long- continued use of 
alkalies, and are not dependent on an cscess of alkalinity of the 
Itloud ; such excess mnst always be slight on account of the rapid 
elimination of these salts by the kidneys- It has been shown by 
Dr. Roberts, of Manchester, that the citrate of potash may be taken 
for an almost indefinite time without deranging the general health, 
jet this drug increases tho alkalinity of the blood, while, owing to its 
neutral reaction, it is harmless to the stomach. 

Liqaor potassffi beai-s the reputation of promoting the absorption 
of inflammatory formations, and is occasionally employed in pleurisy ; 
but its good effects are not evident, and tho disorder it produces in 
tho stomach renders ita use unadvisable for any length of time. Dr. 
Walshc praises liquor pota-ssai in plastic bronchitis. 

Carbonate of potash, in one or two grain doses, given three or foar 
times daily, with a little Ryrup to cover the taste, is much used in 
Philadelphia for whooping-oongh. 

What influence have the alkalies on tissue change ? Dr. Parkes 
ban investigated the action of liquor potassa3, and he thinks that it 
prolmbly increases the disintegration of the nitrogenous sub.stauce 
of the body. Ho believes that his experiments justify him in con- 
cluding that it disintegrates also the sulphur-holding tissues; for 
liqnor potassa) increases both the area and the sulphnric acid of tho 
nrinc. The strong reaction of liqnor potassio unfits it to be given 
in doses sufiicicntly large to alfect in any great degree the reaction 
of the urine, so that when it is I'cqnircd to alkalinize this fluid the 
bicarbonates of citrate must be employed. 

Large doses of potash salts considerably depress the temperature. 
Recent experiments by Fcltz and Kitter and Astaschewsky support 
the idea that anemia is due to tho retention in the blood of potash 
salts. They tied the renal arteries of animals, and injected various 
substances into the blood, amongst others potash salts, and produced 
nnsmic symptonu. Drs. Wood and Reichert find that potash salts 



198 



ALEAUeS. 



inorease aboot equally both Ucnl formation ami bttA dinJpAtioiii 
tbivB);b tlio Rkiii. 

Wbat action 1i«vo ftlknlios on tlw ooiuitjtaonbi of (lio nHno ? They 
lira all repotvd to be ilmratif, lin(, as uo exact obseri'utioitH havo 
b««D miulo vith tluno salts, this istatvinimt mutt Iw regnrdcd as naif 
a probnblo asmniplion. 

Before refenring to the proBamod dtnrotio proportioN of iImmo sab- 
BtancM, it will he vit'M to digTMta for a cJiorl space to speak in genonJ 
tomiH of diurrtica. 

By dinretioa. «rc nndcnbutd inudioinca wbicli act as L'liminatot* of 
Itio nrine ; aod ve mnst distiogaiah dinrctics from tJioao mediciiMt 
whidi, by promoting tiMmo obangi), ciiuiie an invruam in any of Iha 
conatituentH of tliu urine. Diuretics merely soparato from the systcon 
alroady-rxisting produots. 

As the urine ia a complex fluid oontaining, beeidea water, maay 
salts and otber jngrodimitg, iro may haro mudicincs wbich will 
olimiDal« one or mora of tlumo rabstanous, leaving tfao rost nitafleotad. 
Wc may tlierufor« have diuretics of water, or of urea, or of iirio aoid, 
Ac. TboKtontionistlioUood of tnatoriale which should be eliminated 
by thekiduoya may he dae to a variety of oanditioos. The phyiiical 
atstte of bho kidaoys may ho altored. and these orgaaa disablpd by 
diseaae of dlttant organs, as of the heart. Or, through ingnOicioat 
oxidation and oombvution of the offeto products of difiint«i;Tali(Nlt 
refuse materials may remain in a form unexvrctnblo 1^ the kidnoya; 
and, lastly, tho rotontion of tho urinary iitgrcdienta in the blood mjty 
be dependent on arganio discaao of the kidntrpi tbomaolvw. 

Thns, in ono instanco a mMlioino acting on aome organ at a t)i>- 

taniTv from tho kidnojs, aa tho heart or lungs, will bv a diorMio ; 

while in another, those moans nrhtcli promote oxidation in tha likxid 

will prove diuretio ; and, lastly, diuretioa may act immodiataly tin the 

Oidnoys by ronoring or altering thoM phyvioal oonditicnm wbiok 

Wnilnr tho action of iIioho organs. 

Uow far do the membon of this group act as diun.>ticaP and (b 
whii'li of the forsgoing ways Y W« oajuiot give vuiy ntisfartOiT 
naoworB to thueo qnoations. 

Pint aa to tlioir diarotic notion. 

li is gmerally hold tlmt idl thrau substanuea utv diurotjo, and, 
nmti-r cerlain cirviimstanucs, (hoy may (wseibly boooma so. AnMaia 
uf potnah and lurrlnto of aodn rnjoy tho higbt«t repute tn tliia reapKi, 
Uxiiiffh some otirvful obM-rvalions have boun nado with tbeao mb> 
HinnwH ou jK'iiioiu in hulth, wtii>:h linvo Uil U> Dni'xptwtod roasha. 
It wan found by Ifockcr (i|uoU<d hy i'arki'sj, "ihat so Ear fmnt 
acting as a dinratlo in hoaltlii tlio aootate of poUwh dimiBishin] lbs 
wator, tito urai. tho sxtnwtivaa, and, in a nnunrkable manBor, the 



ALEALdK 



199 



» 



Hblijr enltc" Soma n^nafalo obsorvvtions oonocrning the action of 
citrate i>f jKitasIi and noetnte of put^iali, aa lUnrattw in livtUth, hjiro 
been niiulo l>jr Dr. Xunnoluy »n hiiiwc<lf. Me took dail}', for twelve 
dftyn, thic« (o Sve divcliing of clti^te of potnali. On nii nvcrngu, ibo 
(Uilj exoratiioB of water was tDcreased by two oimoas and a half) bat 
th« urea wm lewened by vightjr-foar groinit, aci) tlio Koliib by ^ix%y 
KTftiiis. The auotntv of potash, in dailj doses of from two aiiil a Iwlf 
to tlirco and a IioU dntubni*, oxerUMl a Nimilar luflnvnco in a nomo- 
what leas dcfn^o. 

But khould wa expect nii>dieinL';i to act aa diaroticii or I'liminators 
ia healthy ])orsona? In thoir blood there should bo but little urva 
or urio acid tii be elimiuatod, and wu muHt bi; cnnilul bow fnr wo 
allow physiological oxporiBionts on healtby rabjocta to ^uide us as 
to tUc iK'tioii of diuretics ia diBcoMe. That mch cactioti is hi;ebty 
DOMBsaiy is shown by tlip experiments of Kanko, who, after ^'ivitiff 
ncetate of pot««]i, Doliv'sl n wry considerable inorcuM) in the qnitntitjr 
4>f nrino voided aoou after, showing that this salt will ■omctintee act 
UK a diuivtic of water. 

So far as to thvir diuretic properties ; and we will ondoavonr now 
to answer the second |Hui of tUo fOrogoing qnuetion — In what way do 
ih»y act as diuTVtJn ? 

It is not auppoRcd that any members of this group act on organs 
remote from the kidneys. They may possibly promote oxidation 
iu the blood, aud so rvdace oSete product* t(j uivu, in which form 
tJiey aro sopanited by the kidneys. 

Some of tlio alkalies ilto vomtidored to be febrifuge, as tlie citrates 
and ac9t*t«B. If so. they would act as eliminators of watfr, as 
on the decline of fever, an increase takes ]daee of the urinary 
water previously held hack in tho system daring the fnbrite xlnte, 
and often aocomiiniiied l>y v, simnKjineons Increase in the soltils 
of tha urine. If, Uiorofor^ these sobstanocs will elutuk fevvr, 
tliU incnaso of wat«r and solids must, >» soma measure, be due to 
tbeir action. 

ThcM aJkoliea nre gcaiorallj reputed lo set os diuretics when the 
kidoeya a« diseased, the eitrates nud oooutcs being given in aoalo 
and chrooio Brighl's discaJW. By makiug the urine alkaliiie, some 
consider it is enabled to dissolve the organiu but diseased matters, 
wliioli block Tip the nriniferaun tnlxw in Uright's disease, aud binder 
tbo socrriioa of the kidneys. 

It bos already bccu mentioned, that the members of this gronp 
ri^ndor tbo urine Ims acid, or even aikidiuei hnt, trtnnge to say, tlie 
aoiounl of ncid uxcrvtod with tlu! uriue is actunlly increased, but 
bnag mBtralizod by iho alkalies, it gives no acid rooetiou. 

Tbo oEtratiw and biciirbonatoa oro eonatautly employed to render 



200 



ILEAUES. 



tiio nriiia alkaline, wlioii Ui« nriuaij nrgwa* mn imtated or iiiltain«d. 
as in cystitis aod gonorrhoea. If Ju cfStitiSi tbc nrinL', Iwfoni it 
U pomod, IK alrvody alloOine from d«CDni|K«ition of Uw urea, alkalies 
muHt be iotcrmiitiHl ; for they woald, of coureo, iocrraso Iho alka- 
linitj-, uid, Aaallcalin<.'decompowamach more rtiadiljr than aoid uriuc, 
tJiey would stilt fanhpr promote tlio decomposition of BttB) Hnd tho 
formalion of car)>o»ate of ammonia. 

When excvsB of uric «cid occurs in tLe orini^ it ihonld Iw kept 
for a time allcaline; and, 1>y many carcfut and iukl-iuouh cxperi- 
m«Dt«> Dr. W. Roberts, of Mnnuti peter, has ehown that nnu neiil cal- 
culi may probably bo disoulwd in Ihu bliiUilnr if tltu urine is maio- 
tainod alkalino for eotno weeks. Thia treatment is probtUily uaofol in 
renal caltulas, which ia generally composed of nric acid ouly. It ia 
rsMonnblc to expect that the alkattno urine would in time riTdnco the 
calculoB anffloienUy to pass don-n the ureter. Wu certainly meet 
with patients complaining of mnch pain in tbc back, pawing bloody 
urine^ ooutaining a largo qnantitj of nric ncid crystals, and a liUls 
pns, w1k> are curable with largo doses of citrato of potftsh. 

We may Itere introdnoe a munntory of umo iuleresting oxpcri- 
inente made by Dr. Paul Gnttmnnn, which confirm many of ibn 
ooncluaiona of Clundu Bernard and uthern, on tbo action of potash 
luid «oda salt«. The resalbt nro singular, and acareoly in accurdanow 
with medical experience of Uie action of llieso snbiitaiioes oo tho 
human body. 

PotUB Saim u<* >II Tu mon poimiciu tbaa «>J« nlu. 

fttat U Mlh art sU n|aii]); poimmnu and «qa«llj UM in tli« niD« «|aM «f llna, 
aiwiatoKwJ in tlw aunc v>r. 

ChlwM* (4 ptti^uak nrbonUe of p«Hub, sod niinic d feUtit, la Mcatlal imm, 
uc tiioslly p«a«riHkl t* ioMtij liTc, usil ia Iba nme pcsiod o( liuc^ «t(« »h«s sitku 
h)1, prcriou Ik InjKiloD, i* lulud ulih a hIqiIdu oI albnoim. 

Tli« Mid of tbc Mit pUjn so p«it in U>o tMd remit. 

Is polmkoai iImm fnat niucnlu msknes n** in, flni nfftumg in lb* lilsicr 
utRaltIa i -Mh, In wann-bloaM tainai*, ijwiam* lad OMiniMMi uk« i>laia. 
tatp 4mm laam tlie (rtqaeoc; and ftme «< ikt beart'a b«u^ uiJ MBMlnin mtkt 
ibtm imgttkt. Tbi* bolils (osd wiib all p«ta*b nlu. iMf <ia»m st mm •cml lb 
mUm of Ibo h«u1. vbieh slvij* n m n la act in llo Jiulalch 

naaks SMcrU Ibat tb* action on lb* h«an 1* abttol Umngb ih« rag! uonw^ 
OoUntann ^mtUrn ibl* tWw tmacoua, m, afkr tU r*gl mm Inlli Jtihlvl, niiJ IW 
Btdalls mumt, U« fottah aalu Will tStlkei lb« boail m bafON. oivl vrtm «b«B tk« 
t«gI «w panlfinl ^ vDMilt, Ibo polaab i»lli lUII acttd m uoal on ikU mpia 
WbsUisr iWii eSMt on tb* bwt ia ovjng U Ibelr te&ia <• tbo bcan'o ■sh«aac«« v oa 
lu ffSgll^ UuMmuin cannot aj. B« olaln Ibat tbtM Mha lovsr lb« UlnfnktMtt 
th* b«4r t ^* evHaial; to • rcry InolgDlSoant nUnl. 

IbsN Billi set fcnt ilightl; «a lb« miuolt*. ami not at all m tin porlplmal nsni^ 
■aloM ajiplM iinetij la tbrm in a atnos (orm, Tba loa of MOHtdUljr and smUm Is 
4m to tMr jMaljdnc aotloo on tb« (ploal ooni, aa action tnl odilMonl sad shsI 
ia|wawJ aa tbt Uad part ot tba tonl. 



I 



ALKAUES. JSOI 

SOM Sou, i» hrfW or tkce tion tli« qoulit; which prorM fiUl la lli« MM s< lb* 
IwlMbwk, pndncw na cfeot on lliu tytUm, tiMpt a panlos irakana. 

Bmd la htgu iimtt. ibU nlU nxn bo Milan on the ]i«ut, enow no dimiaaUiis 
ialheumpenturai udprodaoa noapi^nnttlTeotoiitht oordibnin. btttm^ mmurrtd-. 

n« Wrt u( R frnit «iMp*ail«il fn > wlutlun of piitiali qokU; bi mw to tootrael, whilst 
It UkM ft inDch iMgot time to proddM k llko c9«ot la ft Miliition at loia ot oimiUr 

Mfto; todft Mlt* prodoM fts opftdly ot Uio Ittiu in (rDgi, l<ut thi* itoct iu>t occnt with 
inlpbaM <4 Hdii. Oulltn*iin Urown tb«t (Le opuil; U not due to ncrs tUtrwlMn at 
ntcr (mn tli* t«ni : Ihuajtli tU* oMilillan I* mnoTtil bjr Immenuig tbe npaqua l*u In 
wMcT, Thii opanitx ctoo oat t*ko plate io uamniireniai uiiiiikli>. 

liamt f.iiwriiatnt* on cbloridtv bramido, anil imlvlr o( jtolauinni 1 inada, in wm- 
pftDj with Mr. B. Monhtail. load ni to oontIti>.iL>iu timllnr Io tboM anired St bj 
QuItiBUiD. Wc find Ibit Uie>« tluvo aalla praituoD Ibc nmo tjrniptoma in lb« Mmo 
cider, aoil wiii an intvntiijr iirojurtluiipl to tlio iihuudI dI imIwIi Ibtf ccauia. Tbvjr 
at finl doprtaa or dcatiu; the lanctiMiK <tt the >i!eiBEt muck, and Ihw dininiib m 
dcalroT Mnntion and nllrx aalion. Rtdst aoti'in, Uattmann'* ciptrim«ot« ibow, U 
dapT*Mtd altu b; Ihr rclUi aetirm of Iho poUib lalt on tha rtlitx ponicni of lb« copI* 
Vbta tbe (ooctloni at ibe aifeiont nerru bto depnaed, or cron ftbaliabvd, lh« aaiinal 
Mlnioa perfect Totuntarj im«er> Hasro tb« braia, tba molor tract* <t tho card, Iho 
moloi norTUftnd nuclM m atutTootod, neit |«o«raI parkljrtiii bagin^ io ti tim m , aftd 
U hut bae*«M «M)pl«t«, ilae, u Uutliaun hM ibown, to lb* Initbo eSeot «f ibo mK 
at the utd. (See BromUo of Fotaaalam.) 

In DODJunctiDD with Dr. Uutnll, I bare reecotl; mkdc anno lurtlicr in<rtati(>tia(a 
eeoDtnlng th« ftWiaD ot ehlorid« ot polaadaa {Jaamal of PSgiMogy, toL i-, Ko. IV 

Tbit mH, >• Bbd, la ft protoplniinEc poSaoo, It j'otinni all oitrogonoiu tiMW* and 
daatrojt tbwr lanttionii A aubiataDtoua Ujecllon *p«cdiljr«ffMta the bmln Mid cord, 
QMftinf Mtnpltl* pntcnl pamljiia. and in a. Itn boun tb« Dotor norrtt, wbtn dinotlj 
■tinalatoil )>; Iho Enltnupiad cumut. ctaM to oondnot ImprmloM. A littio later 
atllJ tbe Datclc] will oot cmlnct to eltvlrlo lUmnlatlon. Now tbli paialjiia ot all Ibe 
liuata ia duo to the ditMl notion of the potaik, and not to Lb* ajnettd tha dmtliLtian, 
■tnco Ibr ptnljila at the ntnt* and moaelai oorara unch earlier alter pwaonini: with 
tbiaride «[ potaMinm than atlor mtn mecbadeal ftncal ot the drtalali^n, 

Wa oawdgdo alao tbat tli« obloridie aoU Vf an tqnal atfinitr fur all prdlopbum, and 
dslroj* tho liaattM in thu otdor <d thtir liul eadowmenta. rotvii mUn an dopranor* 
aad fWftljMti of tbo baaiL Huw da ihoj |-an1)u Ibo bran t In Iho aasio misoer, 
wg oenctiidr, aa thcjr ]»i«lfie the otbec iliaciurat, b; an allbiitj for nil Ihe nltrceenona 
liwncB. T!i« niorr biKbtr mdowtil nerroiu ranglit *id Ibo tint to luffor, bcneo aoftU 
doaca wlU arreal the hearl. whiUl tlu) lanaoular littu* will aitill mpond Io (altnnlo 
alinalalioD ; bet, if into Ibo jugulu rda a lai^o iiaaatilf of potoih wit i**l onM 
lalroduent, it wilt de4tro)' not oolj tbe fonctiani of ibo narvoea amotarea^ bnt olaa 
nuKwlar oonttaotllilf. Thiii (lultmanD found ibat lb* lajtolioa el antll doa«a Into 
Ibo jngnlar rtia of wa^m'blo<'^«d ■ulmahi paialpa* Ibranch the ■erronaaTftcD ; wbUit 
Traub* found Ibat Ibe injtction of • Uise don puftlrn* alio tbo BoaeuUr llaao, ao 
that it tailed l« tontiul en lb* applicalion ot (alranion. !%«** tii«rIineaU aliMil; 
rapport Iba view* we bar* adtwactd. 

If il aMm >li»n(t tbat «liIonde el [Mtaulna prodnett ndi profouod eJTe«Ea on 
frdfi, wUUt il ipfiaan m Immileii n ilniK Io nui, ire Deed neralj point out ibal our 
trap ««te glrtn ■ qoAtilj i>ropcilliiiiat<j Is troin U le 9 ot*. lor a nna «ei£bin2 HO 
poandi^ and » large n Jom tbmwD at once Inio bla ctranlut'OD would doattiou 
r«i*'M*<llr*''N4tbnetieBi!eal«oiidilioo of Iba blood, and tbe tnnctlsnal aetnitr ot Uio 



A* WTMt of tho curenlaticio \t ItoeU » F«nlT«iig indncoM, «« ooDulad* that unBt of 
ib« tiraolrtiini noMd bj ib» chlond* «j potMiiani mm in aotne (l«tr**i Mi^it >■ liiiMl 
•Mloa ml^ Umm*. 

Ib iba tioftat on BMOild* ot FoUoliun, n hare ilkmrii that il pmiiUM the mm* 
qvptomi, in the Mine «nl«r, m olli«r patwk uiit, and Oni Iba boi« or ]•■ n^M 
indoctiM cf IbM* i^iDploni dapMda an the unonnt of (Dtntk th* mH rwilatM. 
Unmide of [aUatnm, liko the ehloiUEi, paint.oM not onlf tbo ecnlnl nanom (ptem, 
but lUcviH! Uia nerrta, mDMlef, u»l heuii tha oriitral narroiii ifitaai btiDK ■flbrtoJ 
■000(3 tbu tbo ncrT«t, aud tha pwtm aooiitr tkaa th« muadai, and ibortfcn >• 
tonclndt that than ctfocU a( bi«iiitd« «< ^lAjatoiD, which it iKMoiwa ia oamMM vUb 
all potaah Mil*, are dno aolel; I* lite pMiab, Iho bramtdo plajiag m part ia Uwir 
pndactloD. 



SOLUTION OF AlDfONU. CARBONATE OF AMMONIA, 
SPIRITS OF AilMOXU. 

Thkhi prophratioDit bam msuaj proportiM in common with Uio 
alkaline potwb Aud aodft K'otI'' The/ poBaeas a slroog' tvIknIiDv 
TWUTtion, nro fntlj KOlnblv in valor, haw ■ liigli ililTtuion-iiowur, 
and disBOlre tbe ouimcd toxtureit. They differ from th« potash and 
aoda prepnrationa in tbair volutililj-, in Imng mora pown-fol local 
irritanteot the living ouimnl tiintnos, and oxciting very notiro in- 
flAmmotion. 

Their action on tbe slrin i», in many respects, similar to that of tbo 
alkaline polaah and soda prapantiniia. Owing to tbo wator in ill 
OompooitMn, liquid ammonia nianifrats bnt little at4racliDD for tliat 
of tbo tiasnoii ; and saieo itit Molvuut action on tlio textures it leas 
than that of tbe soda or pota«h snlls, its dtfltruotivo jiowon are 
mnoh lees rapid and «xt«nsivo. Owing, bowuvnr, to its liigli diffiuiou- 
poiror, it readily penetrates the cnticnbir covering of tb« body, and 
excttoa a degree of nctiro inflomuiiition snlBcient Ia destroy tbo 
tissues, and so prodaoc, Bret a slongh, (hen an tdoor. The proimn* 
tiwu of the Burmbers of tbis group ore norer pnrpoiuly etupluyed 
to produce formidable deotraotive obaages in tbe tissoes, bat on 
luod in tlio form of Hnimont, or tlio solution of ammonia itaolf. as 
Twioonts and rahefoficntit. 

The strong solnlioi) may be employed to prodaoo very s|tciedy vuaJ- 
eation. A few pinn-s uf lint ithunid bo cut a little larger tbon the 
nK|Biroil I>li«t4'r, and on tbe tint shoold be poured tan or twsDty ilropn 
of the strong solution of ammonia ; tbe pledget mnxt be npplied at 
oBMi to tbe skin, nnd covcrcvl with n good>»i«d watcli-glnes. Heat, 
witli oonitf smarting nud liii^'ling, in noon felt, and in a abort time a 
rim of radnoM appoani around the glass, denoting tliat tboapplicntiim 
Iios done its work ; then a poulttoo promotes the testcation. and i 



AXHODOA. 



203 



I 

• 

I 



tbo bnmiiig pain. In Uiis w»y,a blister may be produced loaMtimes 
in ten muiuteo, thongli it mnj' tmka half an honr ; *□ groat >■ tha 
diffennce in the Tesiostiiig action of ammouia. chat with eome a 
bUater is not tormoA at all. Honco, it must bo comtidured a very on- 
cortain vesicants 

Aa a rnbefaet«Dt, or " counter-irritant," it is mora tuoEnl ; bat it 
i« in DO res]}eot Miiperior to a mustard jioultioe, tba maturitda for 
whldi aro always at hand. The linimvnt of nnimonin, if moroly 
mbbed or dabbed on tbo «kin, acta very iinpcrf cutty na a counter* 
iiritant. It muHt be applied on liat, or linen, kept in contact witli 
the akin, when deoidod rubcfuctiou taken place tn a few nunut«ii. 

As a coDnt«r.im'taut, ammonia is nsod for tho same purposes as 
mustard poallicasor blisters. 

Ainmonia is a usefnl stimulant to tho scalp to promoto tho growth 
of liair thinned by illness. Wilson uaca half an ounce of atrong; 
liquor ammonia to six ounoce of houey water, scented with aliaond 
oU and aptrit of rosemary. 

Dr. Till oxtols Itaajtail's Mdative lotion in the treatment of boad- 
aches nt tlui change of life, or prodneod by ctcfoctavQ ntorino fonc* 
ttons. The lotion, made by nddiuK two onnoca of liquor aminonig, 
and of common salt respectively, and thrro drachms of camphorated 
spirits of wiuo, to tbirty>two ounces of water, is applied to the 
painful jiart with a small sponge^ and is FFnewed as often as may be 
required. It cxoiics a aouaation of burning, and reddens the acalp. 
If too strong, it should bo diluted with wator. 

The weaker solutions of ammonia are aomotlniea applied to the 
bites or stings of insects, as wasps, siuders, Ac, to nootrulizo the 
formic acid, the ftctire principle of tho poison. 

Ponak uiil ii ooDmoiily ku<1 to bo the poiWDOua prisoipla in inaecti, whon bitts or 
•llfigmelM |<aiii kixl indiiiiiniitiun. Tbii, I think, can faanllf bt cumcl. TliO itinf 
nr bli* ot an kiucct kSMU nmfi (ohms toiich inirra tbao otbns. Tho bile «f & bog or 
Am wilt, in one ftrtea, caiiH Muid*nblc xrtllbs, vthilii in ftnotbcr it will smte 
uitbvr piktii n«i<r*l]tni[. Krvn in Iho ninn porMn nc Gad llint pcrimp*, wbn joaaft 
IsMtt bitas or KtLngii »airt«tf slEoeMd blm, vbilit IsUr la Ufa the; oaon muob sitsIIIdj 
&Dit |i>ia. .Agun, ■ bng-bitc irill mom gtcnt iw«lliii2, widlit ia the mou lodlfUiul a 
SM, t, (Ifi, or niii1t«, will taaaa dd iBBuaDikliuii. Tb« biw «l » mUgt, tea, «IU ennts 
«oiHUtambl« •vrlllng aith mnob luhing, luting eight of t«a dip, whllit Id Iha tan* 
penvB lb« bltca ol cAim IntccU are quite inuomoai, Hov this diflaKora conM not be 
If Ibo MtiTe rriarijilc wuf alviji Ui« mme. It ia tviJaDt, Ihanfoir, Ibil tlute niiit 
bs MCM dilCuTaiM ill lbs naiun ot tb* poluo* wcnt«J bf itiffcnint IdkhU, and tbst It 
ttauM doptnd oii lonoio sdd ; or irero lliU tlmjt pnaent in tbs poiun of inacct>, it 
nwl b« miioil wiib mat olb*i tim* 'liHrrinf In lUSamx »iiiiuxli>. 

Salt« of ammonia, applied to the nose, and breathed into tho air* 
pasBages, are oommonly used in fainting, and iu poisonini; by nar- 
oolies, in tbo early Mages of ooh! in the head, and as derirativoii, to 



20i 



AUNOKU. 



remoTO pain aaJ iufliunination of tbo noM and frantal booM. 
Aunioaift inkalntton* hniro bueu recommended in cbronio bronchitis 
to voM, ftiul probably to lessen, the o\-oi'-HbtiuiIiint cxpoutoration. 

Ammonik in tho KUimnch seta much in tbo munittir M it Mtfl on 
tbo skin. It neatra]iic«s Uio ac-iit it nncoDiiliTtt, and itt tUcrefnre an 
anUcid ; at tbo tuimai timu, if iucompl«t«Iy nuatniliiml, it iwts as aD 
• oxcitant, or erea irritant of tbo mneous merobmnc. 

Soon aft4!r tbi' ndniinixtntiuu of smmonis, a (tfimUon of wwrmth 
at llw) pit of tbo Etoiiinch Bets in, wbich i|ttiokl}' s|>readB to tbe rest "f 
tbo bodjr. Wbon tlit' fuuctionB of tbo stomoob and nppcr |iiu-t of tbo 
uit«stino8 an dcprcoood, it may bo used as an excitant. It oftvu 
obviala spnnn of tku intestinal ooaal. and brocse np tbo ntlaxM 
mioonH inonilmuio. Ammonia compounds of tbis groaparo tbeniforu 
among tbo best antispssinodica. Tb«y an nsofu) nmodtM fur 
cbildnm, cspocially for iiifunt'i, wbo aro frequently tonnrnlod by 
oliotio or flatnleut diateiieion of tbo int«8tiueB broDgbt on by bad 
feoding. 

TbeM preparalii>n.H may be pcoRubly employed in tbo after stages 
of dlarrbom, nftrr tbo remorul of tbo irritating excitant cause, wb«& 
tho RiDooua menibnuto continaes to pour out a watery socrotioii, 
wbtuk [Ktrpotnat«H tbo diarrliopa. 

Tbo alkaline preparations of ammonia oro omployod in llatulent 
' distenaion of tbo Ktomarh nnil intostiaos, witb ibo riow of absorbing 
Uio oxooas of gas, genorolly Lionaiatiag of corbonio ooid. In sucb 
aS(«tions tboM rvmiidios no doubt aru often lc-m]>or»rily usofo) 
}mlliativea. Tboy cxcito tbo muscular coat of tbo tDtostino to oan> 
iTacl, and so promoto tho cxpuUion of tbo distending gnsos. 

In full dosos, Umwo remedies excit« an inen:itsi<d formolian 
mucus, and ercn romiling; as emetics, tbvy ikh vrilbout indnoii 
nausea ordoprowion. Tboy ar« seldom employed olone^ but aro usod 
to countonuit tbe di>pre«sLi^ effects of utber omoties. 

H administoroil too long, tbey oxcilo catorrli of the stomaob and 
intastUMB. 

Tbdse sabatauHMa roodily ent«r tJw blood, and must to suou extent 
iiKtmuo its nlkalino roaetion ; bnt owing to their rolatility and bigh 
diffnsiuD- power, they an> rapidly oliminatod, and, tberaroro, e&ort only 
a tranaiont aotioo on tbo blood and tbe organs of tbo Imdy. 

Felts and Riiivr Hnd tbat toxio doisca prorent the respiratory four. 
ttott of tbe blood, aud binder the oxi^tion of Iho nd ooqmsd*)^, 
vtliioh will not al»orb oxygen ercn when it is sbakon up, bloud i 
in this respect like inony other snbstaaota. 

Largo dosos iajeoted into a voinexeite tetanic convulsiottsof spinal 
iirigin. 

in experiments with tJio detached frog's lieart> fed with an artifluiaLi 



IMXOKU- 



i05 



^ 



I 

I 



fttion, Or. SaiuttbnrjT and 1 God tbat ammoninm sftlls, in 
i\ doses, iiwreasw tho strpnglh of the vontricular oontnictionK, but 
T&rger do»R destrof innsanlar coulracttlitir, .Hp(>nt4in«ouii action can- 
tiuoing till contractilitj- in loi't, even when the veutricle is stmngly 
•timalaU-d. Aininoniuu wlta act ucarly an pownrfiilt]' lui potoMinm 
salts on the cardinc mtisouW lissno; Imt lunnioniam salts da not 
treftlten tlw spontaneoaa rlij-thm, and in thitt rrapiM:t dilTor utrUcinprlj 
from ]>otASAii]Tn wiltA. A Urge doso of animimiii injected into tho 
blood of warm-blooded auimalii arrmts the heart at odco. 

Carbonato oF amtnonium, and, in a Ivm di-gfivo, citmto and acetate 
of anunontum, jtroduce porapimtion. A small duse, nnu ur two gntins, 
of C*rbonat«, ^ven boBrljr, genemlljr produces pcrspirntioD as abun- 
(lantlj- &N either aoonito or tartar emetic, lienoi tin UMfiiliioiM in fovcrs. 

It has been niainlainod, nithoat mnch sliow of proof, that corbonata 
of ommooium is the poisonons agenc in unvmia; tho arvn, it m aid, 
decomposos in tlm blood, fnmiK lhi« i-nrbonato, which in its Inm 
prodnc'cH the serioas sjniptoma conatitntin^ uneinii; p«>imning. 

Ammonia ioduooi a sli»,'lit incrcnso in tho forcv of tho pulse, some 
exHtvmimt of the brain, and a general sensation of warmtli. Being 
a slight stimnlant of the hoart, ammonia is used in Minting and 
oxhanstion. It ia frequently adininiiitered as an anti>piwmodi<! — nn 
action depending: probabljr, in gmrt, on its power to strenffllM-n tli« 
hciirt's action, bnt, like all other aDtispasmiidicH, iln inllacnco is bri«f. 

Carbonato of ammoninm is otUm employed as a stimulatinfr u<- 
poc-torant in chronio bronchitis, when the expuctoralion is profosv, 
and the patient's ctroniith iic diminishing. It ia often (ifiven witb 
chloride of aninioninni, which ]>ra1mbty acta in a nimilar maimer. 
OaHxinate of ammonium i.t fr(*qtte.-ntly of signal aerrioe in severe 
bronchitia, or bronuho-pnoumonia of children, cspeeiaUy when thoj 
an proatral« and lirid from obstructed brvatlting. 

^rixinate of ammoninm is largely nsed in typhoid conditions dn« 
to ei^BJpelas, or in tliu othor acnto spocifio fcrcra, pynnnia, iVc. 

Carl»nate of ammoninm, in throe to five grain doses, adminiMtorcd 
unoombined with any other clni^', hourly, or overy two or three 
honrs, according' to thesoTerit}' of the case, has been much landed in 
icarlet fever. It was largely used by the lato l>r. Petirt, who " did 
not load one patient out of nearly three fanodred." The lato Mr. 
Wilkinsim also emploveil it largely with oqnftl snoeota ; and recently, 
Ur. Cliarlos Witt kua vtritten a pamphlet eztolliog it« rirtnes. It is 
• ■aid to be nsefnl in all forms of scarlet fever, esjietfiolly when given 
early, The immedinto effects are stated to bo diminntion of heat, 
fever, and delirium, and n disposition to sleep. Sir. Wilkiimciu saj-s 
it ia eqnally nsofnt in measles, and that the ammonia treatment leasts 
no socoDdaTy evils. 1 have nsod this traatment largely in mMsles, 



206 



luascsu. 



appBrentlf witli consid^rablo benefit. Carbonateof amtaoniamindttOM^ 

fnxi pontpinttion, aii(ln|)pu»nito doTelopthontsliiind cansoUio dis 
.to mo a ben^ conrm. Mr. Charlm Witt BftjH, cnro miut be take 
' that no Bold driukit nor lu-iil fruit* of nnj kind UDpnrmitt<;i), nrtboiun^ 

moniAi bdcomint; neutralised, loses it« eSicttcy. Solution of acetate of 

aBuaooiain, find citmto of ammonium, ara uofnl diAphorcticii, and 
tuo largely employed in fewre. It is especaally neef nl in tbe milder 

forma, oa in common catmrli. A foil doae of aootAto of an 

or MindereniB'B spirit, will oft«n apeedily stady and H>bar 

dmuknnl. The aoppoiicd effect of ammonia in pravmtittg iodis 

ia noticed in another place. 
Anunoninm salts am pownrfnl antiitcjiticii, oapociiilty tho tiqnor and 

Mrtwmate, and possibly thoy may act heiwficiaUy in the aonto npooifia 

■ feren, in xirtno of tUiit projiorty. 

Owing to iU hi^h dilTusion-powert ammoua eacapcn very njadily 

from tho body in rarions wnyK, n portian pnuin^with tbDbnMtli,BomaM| 

pnbnbty vritli the sweat, and mncb vrttli the ariwi. 
The tABle of carbonato of ammoninm is much mnsJcctl by ndminis- 

teriog it in milk. 



ilAGNESIA. LIGHT MAONKSIA, CARBONATE OF MAO- 
N-KSIA, LfCUT CARllONATE OP MAOXKSIA, SOLU- 
TION OF CARBONATE OF XIAGSESIA. 

Tbssi ntbatanooa, having an alkaline nxtctioa, might be placed in I 
^Toap of potaal) and soda alkalies, bat the effect* of tho : 
pMOp on tho )'0>ty nif, in mnny rospocta, very different from Ihoae of 
the poliuili and wda grouih Wo haro ebowlien troatcil of tho jiro- 
portioi porljuninir alike to all alkaline rabatonceai inolading, of courav. 
tho metobers of this gronp. {See Potash group.) 

Soma of Lite oxide of magneaia combines with the acids of the 
gaatnfl jsioe, and becomes iK>lnl>lo ; tbo nmainder, being nnnffactod. 
IS loft iiwolnhle. Ptni. of the carbonate, deoomposod by the addH of 
Iho Htomaoh, seta free its carbonie acid. 

Tbcaa mbttancoa act as anlaeids and aa antidotn, in poisaiiltift by 
thfl atroBg bomIs and by lonM metallic snltSL In eome cnaea, tlu^ aru 
prvftmble aa antorids to hicarlxinate of soda or limo. Tho adran- 
tagca of the mcrabvnof this group are; — (1) thrir large sntunttng 
oqiacity for ncid ; (i) Llioir purpitiro property ; ^3) their Iian»lata> 
turn, on account of tlieir ioaolabilitT, when given iu oxcuaa. 

Thair dimdrnnlage consists in tlunr great bnUt. The oxido or oar- 
boiMtc of magnosia is gentnally ukkI aa an antacid, bat the iixiilo is 
[>rcf«mbl4 aa the varboatitv. by giving oil mncli gas, may [irodaco 



MAOKKKIA. 



207 



dingrmftblo liieUnsion of tho stomach. It mnst not ba forfi^tfon 
that thej an mcreljr tcmporixii^ Tamoclies, nod tbat acids »n} hr 
better corraeUves of aoulity of the stomooli. (Sec Acid«.) 

The oxido of iDagoccia is iv conreaient luitidoto to tbo strong 
mtnenl or vcf^eUble addft. It ueatmliuw them, and ]irot«ct« tko 
dolicfttc Ktrnctares of the stomscb from tlioircorrodiog action; and 
it precipttat«a nuuif inetaU from their odds, ruiidcring tlicm Uim 
Rolnbto, and, therefore, lesa poiKmons. The magnoBiiis form ui 
iuBoluhle oom))Ound with unHmlo, and thm take nnk uuoni; tbo 
■olidotcs of this poison. 

The inBgnetttan wit* combino In port with the aoidR of tho gnctrio 
jnioo. The ozido imcl carbonate, on aooonnt of their InsolubiUitj, 
cannot puts into tho blood, nor dooK tho chloridu piuw in lutjF' omonnb 
bccAQseof its low diSoaion-i tower, llunce, almost nil tuo raofpieeia 
pOMeii into the inbortinos. 

In the intoatinee, the salts of msgnoiuD undergo changes oocording 
to their oom position. Tho chloride, probnblj, is donompoiwd bjr tho 
bile, and tho oxide precipitated, p*rt of which combines with the 
bilinrj acids. The oxido in converted first into tho carbonalo, tbcn 
into the bicarbonate by tho carbonic orid of the intcattiies, and so 
mode soluble, and caiiable of acting; as a jmrgntivo. Tho cnrboaato is 
changed in a similar manner into the bicarbonate, and likciriae 
bouontcti u pur^tlrc. TliuN they act iik purgiitivcr; onljr after 
conversion into bicarbonate^ in which form the}' poeseeii most of tho 
properties of the group which include* sulplukto of magnesia, d:c. 
Ltko tho members of tliis gronp, tho bicarbooato has a very Inw 
diffasion -power, and, tiko tJiem, it in purgative; it« action in this 
raspect being rery mild, It is termed n bxatirc. Their mild action, 
freedom tma tnitto, and antacid property, Gt thusu substftncoa 
admirably for children. They arv generally combined with a 
lilllorhub*rh. If unduly employed tbey occasionally aocumuhttc, and 
form coneretlona of ommonio-magncstan phosphates in tho inteHtineii. 

Bioarbonato of nuignccia, flnid magnesia as it is termed, is a osofal 
and mild aperient. 

Magnesia lias been lauded in sympathetic vomiting, as that of 
pregnancy, when It Is to be prc-sunied tho romiting depends on 
cotceesire secretion of acid from the >toniach; but itx effei^ts arc 
TGiy tmnsient. Should it fail, reconrso may bo bad to oxalate of 
aerluro (oue grain every tfarog bonis), ipeciwusabo) qiiiniiio, adds, 
&c, (Seo Ipecacuanha.] 

Thu chief of (he raagTuwia pMMs oat with the fiwaa, ud, for tlw 
reasons stated, a small portion only enlets tlio blood. In excess of 
uric acid, members of tbix f^up prove nwful by satumtlng mnch of 
the acid in the itomuch, and corrytug it out of the body. 



tiut. 



LlilK. CAUSTIC trUE. LmE- WATER, LINDIENT OF UME, 
SACCUARATED SOLUTION OP LIME, CAllBONATE OP 
LIME. 

Tins grOQp oontaina higltlj valuable nedietafil sabetatices, witioh 
uiglit with ftdvftstngo bo more oxton!tiri<ly nitod. 

Lime is a necGcuinry <!onatititent of the hard and aoft tiasnos of Uie 
bodj, of honis and tko pnrtjt morv ritoilf ondowod, M (h» neiTM 
and mnsoli!)! ; wlicrercr th«r« is ootire growth, whetlin* nMond or 
unuatnnd, time baHs nro found hi excvw, probably ti* yiumph*Uf, 
helng io all HWihood tho fonti at lime roqaired by the body for Iho 
]ierfuTmaDce of many of its fnnctioiis. In praottcc, tiowcvLir. wo find 
tho other salui of liniu of eqtud serrioo in ulmoat precisely tho ftono 
morbid xlutos in which tbo phonphato in lo vftloahlo, and it ftomnt 
fciwiMo tliiil a portion of the liioe salta becomes united in the body 
with photiplvoric acid. 

Thoir diSoMon-power beinff vety low, and haviajf little affinity for 
Miinutl Btnictoros, when itpplivd to tho skin they pmdnco very litUo 
olianci-. But enoBtio liniu, h«viui{» Btroii).- attmotion for w»ter. will 
withdraw il fn-im Mii> dermis when dcprivMl of its cuticle, and to 
•ome extent eSeot the defltrnctioii of tlw tinnie*. Yet, um jIh dif- 
fnsion.powor is slight, it fails to punotniio tlio Itesnee, and its action 
is miwrficinl. CinvtJo lime i» not nflrii naud hm an roi'horotie. 
Itlixc<l with caustic ])oliisli, it formti a i-omponnd less deliqueisceiit, far 
nioru roanogeMblu, and nfor tluui iiiiii]>k' canntic potanh, especially 
in BffectioQB of tho nock of the ntoms, as Bnt pointed ont by Dr. 
Ilenry Beunct. 

AfiplinI to broVen akin Mid lo ^orw, tho carbonate and lime-wa(«r 
ar«< Hliijtitly AHtrinttciit ; henoe lime !« Homotimes nwd to check the 
tliwhai^ from Eorce and skin omptiood. 

liinM-wator and oil in equid quantities, or in tho proportion of fonr 
of limo-watOT to one of oil, enjoys a liigb reputation in tho trestnuol 
of haraa. 

Limo-wator ia of somoe as a lotion to orackeil nipplrs.* 

Line-water ia saDtctimai employed to chock the abundant diact 
of certain nkin diRovMS, oa ecwma, and likewise as a Mxlative to ' 
tho smarlttig and tinjfling. When the infianmatioii of vczenu haa 



* Ta (nmt cfodMil oipplM k lu Mt«r sad nneh ssiht tiwn (• «ni« tkm». 
IntninUitalj t^ tlilU It r«a>ot»it Imia iW braut tba nlpplt iIwbU U MnlaUj 
wufcnl noil diwl. n* nijiplai oitf br buil<>Md Vr *bI>><>K llifm mm* *k»n Una 
Ufor* •lattTM;, anil dUr meb ncklJaf, villi s lIUls bn«d; and wiMr. A ibK MM 
I cuotluU; OTt* th« alnJa is botk bMllai tod ptvlMllis. 



LIME. 209 

been subdued, the discharge being great, lime-water and glycerine 
form a neefiil and comforting application. 

Carbonate of lime is sometimes used as a dusting powder in eczema 
or intertrigo, to absorb the abundant secretion, to prevent diechargea 
from irritating the already inflamed skin, and to protect the skin from 
the air. In common with other dry powders, carbonate of lime is 
inferior to soma simple, blaiid, or slightly stimulating greasy appli- 
cation. Certain cases, however, are certainly more benefited by dry 
powders, as oxide of zinc, bismuth, and carbonate of lime, than by 
ointments. 

As we have said, carbonate of lime is used for intertrigo of the 
buttocks and perinicnm of young children, and to protect the skin 
from the irritation of the urine and of the air. Napkins soaked in 
urine being very generally the cause of this eruption, it is obviona 
that greasy applications a^ord a more efficient protection, since the 
powderreadilyabsorbs discharges, becomes itself irritating to the skin, 
cakes and cracks, leaving parts of the surface exposed. The beat 
treatment indeed consists in frequent ablutions with soap and water, 
and anointing with greasy applications. 

Lime-water, on account of its astringent quality, is used as a wash 
in discharges from the ears and vulva, and is of most service when 
some active inflammation is still present. In the chronio stages of 
car disease it is far inferior to the glycerine of tannic acid and other 
astringents. 

Dr. Joseph Boll recommends lime-liniment with cotton-wool to 
prevent Rmall-pox pitting. Cotton-wool cut in proper shapes is 
dipped into the liniment, and applied so as carefully to cover the 
face and neck, leaving apertures for 'the eyes, nose, and mouth. 
No cro\-ice must be allowed, and a lai^e handkerchief must be tied 
over all, and the dressing allowed to remain on until convalescence. 

Lime-water, probably owing to its alkalinity, is often useful as an 
injection in leucorrhoea. 

Chalk makes a good tooth-powder, and is safer than powder with 
hard and angular particles which wear away the enamel, and lay bare 
the dentine. 

Lime-water is occasionally used to lessen the discharge, and to 
promote the healing of inflammatory and ulcerative diseases of the 
month. 

Solutions of lime, as lime-water, will dissolve false membranes, as 
diphtheritic membranes, and either lime-water itself, or the following 
formula : — Calcis half an ounce, glycerine two ounces, water eight 
ounces, is used as a spray. It should bo used frequently. Though 
strongly recommended by several excellent authorities, still this 
treatment of diphtheria is of donbtfol efficacy. 

V 



210 



UXE. 



Lime jircpncsttoRs DcntT&lnto the acid ia tbe tlonukobi lint othor 
roDiedies are uo.iLIy prefurrc<l. Sftlte of limo tm as«fnl in oxalic 
acid ]KiiiM>niDg. 

It is iu>t eOMj to indicate preciscljr the tliorapcntic valaa of lim^ 
wui«r in roniting, bat in somo form* of it, few rcinediiw am mora 
BKcfal. It is gvninnlty ttcrriovablo in cbmnic vomiting-, thiw it 
often arrests tLo vomiting frooi ohroiiic ulcer of tlifl Btoraaob. lb 
vhoald be mixed n-!t1i milk, i>ithor in oqnni ]iftrt«, or in the propoitiou 
of ono of lime.watcr to fonr of milk; and if the Tomitioir i« in- 
cenanl. Die pntiont sbonld bo fr^l onlj on tbiN, in froquont aaaU 
(fOtntitipK of a lea or labIe<i|ioon(ut. Young childron often eject 
muoli of llu'ir milk in Inmpy iBBaua ', somopftMing into ttic intoHiiaes, 
nnd McapiBg with tlio motion, canse'in tboir ttanstt mncb wind and 
Huverc oolic. Cows' milk is apt bo indncio this conditioit, as gmttrie 
juice OOBgolatee it in lamps, while it genornlly coaf^lntos hnmau 
milk in 6na fiakes. liim«.wat«r, by provi-uting tlii* lamp; ooagn- 
lalion, olieoks this kind of vomiting generally at once; or, falumld 
it nootinno, the rejected milk iK no longer cnrdk'd. In i;a«e of cod* 
8l]{)ution, biL'arbonAto of mkIa slionld be enbatitntod for limi;-u-»t«r. 
Onc^igblb of limiswat«r is gvnemtlj auflicMnt, but thijt failiufr, a 
lavger quantitj, even equal part« of each, shoald Im triod. ilalf a 
dnobm to a dmdim of biuorbonBto of aoda abonld be addml toa 
pint of milk. The&o remedies both sometimes fail, and it maf be 
iMcaunrj for a time to witlibold milk, and to feed Iba diild on 
>opp«d bread, water grael, and chicken broth, or real bmth. 

Tht> vomiting occurs in early months of Ufe^ somolimM eraa 
during suckling. If the child is brooglit n]> "by luuul" tho milk 
sluiuld be anfficicntty dilut«d, and during the finl month wilb at 
loBit nn eqnnl qnantity of water; indeed soRve antlionttcB advise two 
jurbi of water to one iif milk, the rvlativa qaantity of milk inorokaiag 
as the child grows older. A child a month old may lake a pint to ft 
pint and a half. Dr. Alcig<t, of Philadelphia, reoommemls an axueUonl 
food for hoalthy childron, nnd especially for those eufleriug from iha 
kind of Tomiling nndrr <>uuBidi.-rution : — Soak a sernplv of gelattne 
in a little cold water for u short time, and boil it in half a pint of 
water till i( is dutvulvcd, that is about ten or fiftera minutes. Just 
befaro finishing the boiling, add milk with some arrowroot mailo iatii 
jiaste with cutd water, nnd afterwards kudio cream. Tho proportion 
of tho milk, cn-iun, nnd arrowTOOt, depends on tile age of the otuld. 
Kor an iiifanl less than a month old he Mlvises tlirvo to fonroaooas 
of milk, a tenspnonful of nrrowmol, and half an ouoco (o an uums 
of cn<am. In half a pint of getntiiiu-water; for older vhiMrvn i1h> 
milk may bo inereasod to half or tn-o- thirds. Tba |[elaUno and 
arrowroot pivTonl the luapy cougulaUon of tlw) ntik, while t^ 



Lin. 



211 



small quantity of arrowroot will uot diaordcr tiio Btomacb. If eron 
thie food is rojoctod, than Hiltite tfao milk with three or oven four 
parte of n very thin decootion at arroivrootv or tiy merely cream luid 
watvr, one part of croam ia tliroo or foar of water. Thia food ran- 
■iltiiig of miltc, croam, arrowroot, and gulatJue-wntor is very asefol in 
diittTluBa. 

Again, in yoang children Boftering from chrnnio vomiUng and 
diarrhcM. and comequent wasting, limo-wftlcr is often of frruat 
benefit, iropToviag digestion, and appaKiitly aiaimilntion, nnd ob- 
viating that highly irritating etato of tho artno, which so cominoulj 
OOOOAionB interlripj. 

Solatione of thuM salts piuK but slowly into tho blood, on account 
of their Ion- diffuHiun- power, hence the (greater pert padH tliroagh tbo 
intestines, and arc nltimatoly Toided with tho tmcps. 

Thcjto )iiilMtanc!L>!i nculraliBe any add preeeiit In tho intcstiitos, vnd 
check the eecretion from tho mnooaa mftubmni:; and, Bomotiinos h^ 
ODD muani), and sometimos by both, act efflcacionaly in diarrhea. 
Carbonate of limt', ami, iu a Iw* dogieo, Ume-watnr, clcticr\-edly hold 
» high plnoo among romodics for diarrtxea in tho latter sta^s, when 
the irritant is gdt rid oF. Common ciballc mixtuR^ i» uHrfnl in 
diarrhoa dopcndin);; on more serious caaEC«> as otc«nition in phthisis 
or ^hoid fevor ; but in tliow graver eoMa other rcmcdim arc to Ix) 
preferred. 

It has boim eiid that xncchnrat^d Kolution o( limv dooa nob oonJhio 
Uifl boYTolK, but, on the contrary, re1iov<« constipation. Tt slioiiU 
Dot' he token on an omiity Ktomach, leat it exuitc naoscA. 

In aerofnla with glandnhir cnlargemontx of the neck, in cane* re- 
sembling talioa mcwDterioa, and chronic diarrhow with weak digestion. 
Dr. Warburtoa Degbie extols chloride of calcinni in ten to twenty 
grain doaWi gireo in milk afti>r food and continued for a conitidcmble 
tinw, ita good effects, in many cases, not at onco becoming apparent. 
It is reoommendod too in phthisis, and many writers n^port fnrour. 
ably of this truitnient:. 

Lime-water ie repntod to be nsofnl in whooping-cough, and thia 
may woll be, owing to ila oftnnfteQoj ; for, in certain forms of this 
diseaae actriugents, as alum aud tannin, ofton ol&tct a decided im- 
proremcnt. 

Ume-w»ter ia a nsoful injection to destroy the thread-worms 
whieh infoM the rectum. It has been also need aa nn injection in 
gleet 

From their lew diffusiou.jtower, a small qnnntity only of theito snb- 
stances pMsas into the blood ; so araall, probably, that it may well 
bo donhUd if they can iu any way in6uonco tho organs remote from 
tbo inteetiDee. But exi>erienoe shows that lime-water or carbonato 

p2 



212 



VHOSPBATB or LIME. 



of lime is ft T«laabl« remody in deficient nntritioii, ani, in oonvalw- 
oeoce from Mriona diseaae, ito good oSocts boing most nuirked in 
cbildren, tn most slagM of rickota, nutl-niitrilion, &«. 

la Koroe instanoeR thcee good resnlts nro tmceablo to the turtion of 
tbo limiNvalt* cm tiic mucoaK nwTmtirimf of the inUetioM. Tbv 
action of tbeso salts, bonevor, boing very similnr, altliottgh inforior, 
to tbat of pboMphnto of Hmo, wv refer our rcoden to tbo eoctioD 
which troate of this salt. One point nmy bo noticed bom, oonlimcd 
bjr both theorj and oxpcrieDoe, thut ninall will do M much goMl 
as largo doBce, ainco bot tittlo of tho galigtAncM posse* into tbe 
blood. 




PHOSPHATE OF LIMK. 

Trih atlt is of rCTj great importance, both in health and in diwaae. 
It niniit bo mnked among tho motit valuable and ncocuaty foodis 
being probabljr aa nxMntiol lu pmpcr growth and nntrition u tba 
nitrogenous aniil fatty foods. Obsert-ationH liitvc abaiMlantljr provod 
il<i phjiiologicnl importanoe. It give* aoliditj- to tbo sktrlolnn ; honoe 
if the qnantitj- sopplied to the body ia small, or if the dmnund for ii 
in gr<«tur than tliv t>apply, tbcito Solid stractom snffor and Uwe lh«ir 
rigidity. CItOfSat produced Eoftening of the booea of animals fed on 
food five from limc-Kalto; nliilo, during pregnancy, mnch pliosplist« 
of limo being roqnirod for tho osaiBoaliou of tho akdetou of tbo fo'tns, 
it ia found that the fraotarcd bono* of pregnant womon nnilv slowly 
and iraporfoctly. Somo exporimenta liy Mibi«-Edirards boar |mou. 
(rally oil thill point, for bo found tliat animals' bones int<tntlonftlly 
frautnred nnitcd more quickly when tbo animnls irera supplied with 
pbuaphativ of liino. 

Tbo urine of pregonnt womvn is nid to bo deScimit in HnKS-anlls. 
but on tbi> |>oint ike evideuoo is very diHcrcpMnt. 

Tbo canlinal importance of tliis csaontiul fooil to llw aoft and 
growing tisanea is to piomoto oclKgrowtfa and nntrition; and tb*l 
this ia a very fcaoiblo ounclnsion the followiap oonaidonitions l«nd to 
allow : — 

1. Tlw pntaonou tt this salt tlironghont the body. 

2. Its preaonoe in ranch latgw propottion in Ibe intvniBUBlnr Said 
ot the body than in the hloud ItaoU. 

3. The fact tliat in horbirora llie intercellular Hntd is aa rii-h ia 
Ibiamlt as it is in caniivom, thongh tbo vcgrlablo-foudon tnko 
liltlu III it with tlutir fond } benco it rand Iw varaftJly rvtaioed in th* 
intvrcvllular llnid tot aome impottaat puqioac. 



PBOSmAlE or LIMK. 



213 



4. Smith's atiEOTv»(ions slioir that n ovrtuii] quantity of phospfaata 
ia reqnired to titijiply tho first bnaig for the new tbtiuci, evt-n in t^o 
ctme of those oi^iins vrlijch iiiilNKsiucmtljr exhibit an «xceaa of oar- 
bonatd of limv, a» tlio shells of Animals ; aa Dbservatioa showing tlwt 
[thottphnto of liin(< ia oeoesaoiy to initiate f^^wtb, aufl, in this respect, 
is not intvroUaDgiailtlo willi tho CM-bonati.'. 

5, Wbererer crfl-growtJi is ootirc, thcro is phoaphat« of lime ia 
OXCM8 — a statcmont holding; good both with ragard to lioolthy and 
disctued growths ; for tliis salt is found to provail in diseaeo asso- 
ciated with rapid formation. 

With rvgard to tliu vccoud and tliird points, it must be bome tn 
mind that pliosphato of lime in tioltiblo iu acida, and, us Itic inter- 
cellular fluid ia aoid, we shonld expect that tbo phosphate would 
accumnlato in it. 

Thooretically, it might be supposed that abandant data exist to 
enable iik to foroniit tlj<i occamons when to employ IhiH siJt Tt>mc- 
diAlljr; it would bo rightly asaamed tliat in defoative nutrition, or 
deBoient cdl-grourth, Ihii phonjthnti! of lime would prove oervicDable. 
Cn^in bypotbotical objoclious have, indeed, been urged agunst the 
empl(>ymcnt of tbi« nalt. The faalt, it htui bent aaidf in ronlty not 
^d«SoJeDcj of lime, but inberea in tbo tissues, which fail to 
il; timt, in cn«n of dofi-ctivo ci-ll-growth and of mal- 
nntritton, the qnantily of the phosphate in tbo nrino is unnsually 
graat ; and, coiiscqn«ntlr, our cBorts Hhould bo dircftud to rcmoTO 
rhe circnnwtanecH which check assimilation, for it ts aa little reason- 
able to treat diflbot«s with sngar, as a dinbctee of ]>bosphatc of limo 
with ]>hnis{ihat(; of Ume. Some irntli no doubt there ia ia theso 
Klrictnm, and too much attention cannot bo ]mii to tlii^ hjgienio 
condittoiui favourable to aatimilation— good air, abandant light, and 
Bul!ici<Dt exorcise. 1'he case before um ia more analogoun to nnomia 
tliaii to dinliotc*! ; and we ^ive iron with dtiuidod bvndh in nuiemia 
wbcre this condition is doe, not to want of iron jn ibe food, bat to 
the non-awimilntion of it by the tissues. TIm) elficiicy of phoapbatefl, 
however, must bo decided by «s))tiri«nc«, and experience Kjicaks 
abnndantly in tbeir favonr. Bcncki', to whom on thin subject wo 
owe mnph nf onr knowKiIgc, Ixitb pbyaiolo^oal and t hempen tical, 
hnn iliawn that phospbaiu of liiue is especially useful iu those very 
disoaiicH whfirein it occani in oxcc«K in the urine, as bectic and obronia 
wasting disease. 

This wait is of grmt oso in the ancemia of yonng and mpidly grow- 
ing persons, and women weakened by rapid child-bearing, prolonged 
•ufrkling, or cxoeKsive mouMtrnalion. In cbockinff chronic tuhoroular 
aud iioii-tnl>eronlar diarrhcea, nud other profuse disclinrges, aa in 
I lencorrboMt, chronic bronchitis and largo abnocwcoi, it ia \ ralnablo 




214 



PHOSPHATB or LIIR. 



mnedj, elfdctuig id iUmo ittatMi both genetsl ahiI IneiJ iraprOTCmcnt. 
hta^taki Bpeaks highly of its inflnence on scrofulous soni§. It » 
useful nlso in onricx of (lie baii««. 

Tliiii sole is Kpl to bo de6cienl in tawnKlwelliufc women, who im- 
prove uuilor ita Kdminislnilion ; nn incnuutiid tjauititf, too, linds its 
wDjr iaio the lime-laekinf; milk of a sncUing mother, who with bar 
child are thus umDltaneoiiMljr lMmcrit4>d. 

PcTBoriH in broken health twota prolonged town life or overnork, 
or who from oth«r o»uM wo Iftngnid, hipped, and inckpiiblo of mnoh 
ox«rtioD, often dcrivo niucfa benefit from this medidne. In cnsea like 
thia, a good formaln i* n ^rtin of phosphate of lime, phoxpliftto of 
iron, and cnrbgnntc of limo ; but phosphnlA of lime will act admiisblf 
bj itaelf. This modicinc in atotal in tlio chronic forms of plithisiN 
with little or so fever. It sbonld be taken on tbo tongno either drj 
or mixed with n littlo milk. 

No reasouHlilo donbt can. I think, be entertaine«l of the cflScacj of 
pho«phnt« rif time in many vOMrn of rickets. 

It has been son^'ht to Mtablish a connection in all cnsw botv 
rieketa and n doficiont aapplv of lime ; it in nrgod, Hrbtly, that rick 
Domnonljr occur during; ihe first dentition, when mnoh lime ta 
required by the growing tcvth, and, wcnrtdly, Hint rickets affect the 
children of mothen in just that state of ill.hcalth in which it has 
been MtahliKhed that the milk in deficimt in lime. Them may h* 
noeh truth in these slatemcnts ; but as in many cases of rickuts, an 
exeeas of lime in found in the urine, thu dittcnM in such easea cannot 
bo held to depend on a deficient supply of the salt, but mual be duo 
to other oirenmatancei^ with which, nt prevent, wo arc only paKially 
oogniiant. In ca«M where the diaeaso is dejiendent on deficienoy 
of pho^uitc of lime, its administnttion in obriouly nil that U 
nH|iiired. 

A <ldklsii«y *l lime ktkd |4iMpWi« Mid in load i1«m twt pradae* la aaiaab ths 
nhMgw olikn«l«rl«tk «t i Id:*)*, bat *b« Uot \mnmm ln«^. 



la rickets, moreover, tlien is not merely deltctent oHsiScMiua of 
tlko bone*, bnl tumatoml ffrawtli and defective nulritiun, bcith i» tlio 
skalebn and in the other textures. The plioopluitcuf lime appvam 
to control tliis defective iind pomTnto nntriticm, and tu imlnoe hmlthy 
f[rawthi so u not merely to favour the consolidation of the akolotOD, 
but to impro\-Q tlie condition nf the soft organs, aiul eX|»rimeo 
shows alnindaally tlmt mnny rickety eases aro UmuAUnI mtiro 
daci<ladly liy lime-talts tlian by any other single dnijif. 

German authoritiua, who have studied thia subject most atten- 
tiToly, ooasider that (he fittest time to give tbb rvmsdj is aft«r tho 



PUOSI^ATB OP LIUB. 21S 

cessation of the active st^;es of the diBease, that is, when the paina 
nod tenderness of the bones have disappeared. 

It is well to repeat a cantion against the naelessness of adminia- 
toring this or other lime-salts in large qnantitien, for, owing to their 
very low diffnaion- power, very little passes into the blood. A grain, 
or two grains, eeveral times a day, is a Eofficient dose. Given in 
excess, it hinders digestion. 

Phosphate of lime in the stomach most be varionsly a&ected by 
the free acids, as lactic, hydrochloric, and, in a lesser degree, acetic 
acid, dissolve it. 

Most of the phosphate passes into the intestines, where, if the salt 
is administered too long a time, it is liable to form coacretions. 
Being nnaffected by the pancreatic and biliary secretions, wad bnt 
slightly solable in the intestinal jnice, most of the phosphate passes 
oS with the stools. 

Phosphate of lime is highly recommended in various forms of 
chronic diarrhcea, and especially in that of young children, to whom 
it may bo given with carbonate of lime and lactate of iron. Whether 
the beneficial effects aro due ta its direct action on the mucous mem- 
brane, or take plaoe after absorption, in the manner previously 
described, onr present knowledge do«i not enable as to decide. 

Being soluble in the acids of the gastric juice, and to some extent 
in Bolutiona of common salt, its passage into the blood takes place 
probably in several ways. It has, however, been doubted whether 
any portion, if nncombined with food, passes into the blood, since no 
augmentation of this salt ie met with in the urine ; nay, in some 
cases it seems even lessened. The observations on this point are, 
perhaps, too scant to set the question at rest. 

!Mnch phosphate is taken, either in combination with the food, or 
GO intimately blended with it that it is well-nigh impossible to 
separate it from the tissue- forming snbatances, and so it finds ready 
entrance into the blood, with the digested materials constituting the 
chief, and, in ordinary cases, the only source of phosphate of lime 
fur the supply of the system. That so alkaline a fluid as the blood 
is capable of dissolving the phosphate is explained by its solubility 
in solutions containing free carbonic acid or common salt. 



iu 



CBL0KIDE8. 



HTPOPHOSPHITE OF 



LrME. 
SODA. 



HTPOPHOSPHITE OP 



Dr. CmiociiiLL recommeDtls Ihose drug:) in i^tliius, and Uia Mlat 
meiita rcgitrdiug thitir action liitve for the most piui boon upbcM Lj 
Dr. lliorowgood and enmo other obswrwB. 

Dr. Churcliitl <!OnuiiCDoes willi a grain and incraiKeK tho doae to 
aix or scvon grains a day, giving it in the form of Bjrup or pill. 
Dr. Tburowgucid given n grain ihrL-e tiuu« a daj in tbeformof Hj-rnp. 
In too large doeca it maj iirodnco wroaknom, alaoptn«BBi headaclie, 
giddioem, noi«iNt in the cnrx, loeii of ap[iotiU), colic, diarrtwi'n, and 
weo Mecdiug from ike noac and langg. [)r. Churchill administers 
then a^nU unoombined, and cnnliunH nKnitist giving thuni with 
iron, codJivur oil, or Ntimiilanls. It i§ said that tbe hy|ir>pbo-i|ibitm 
incmaeo npjicititv and di^'ii-itinn ; proniotu ihu formation <>( tbi* IiIoimI ; 
U-HM.-II congh and expectoration; relievo ])ajn in th« etde, and 
diarrhu<a ; and often eSoot a oaro. They are mid to be more luteful 
in the lirat tlian in tbo tKcond Ktngv : and in tbe second than iu tho 
tbird HliiKi* ; nnd when only tma Inng i^ affvcted — a ntaliMnent 
Huifit-iL'Dll)- ubvions and npjrlicAbl« indeed t<> ovwy rvntodj*. I'bi'Tutf- 
good way* lliny aro more 8acL-c««fa] with .voting tbiiu with old people. 
Tbcao roniLilioa am also nvoinmendcd in niTvoas aud gcaetBl 
dobililj- ; iMttbtng ; npcnnatorrbutt ; obtui-ooia ; and nnninia. 



CBLOKIDE OP POTASSIUM. OUl/JKIDK OF SODIUM. 
CULOUIDK OF AMMONIUM. 

I'mm snlirtanceo, having many eheoaicat and thcntpvutio •jaaliUea 
)n iwiuRioB, have been grouped together; but the rcmarki in Ihla 
HCK-tion rvfciT mainly to chloriile of ammonium. 

Thoiie iwUa are frvcly solable, and |kwiws8 high dilIu3i<)u-|iowcir. 
The taltith tnaio common to thera all i*, in tlie cam of chlnriilu of 
anunoninm, Huinonlial dingnwaUe, iml oonvtitntoe odd of tba 
objeettoDBto its use. 

T1m<m chloride* coDntderaMy increase the accretion from ika 
mncoug membrane ; and may indMxI t^wn uiicilu entarrli. Thia ia 
notably tbo omd with chlori<lv of ammonium, which k ooDNB<ttu)titJy 



CBLOBIDEE. 217 

employed chiefly wheB it is propasod to inflaence tlie mncoua mem- 
brane. How do these chlorides promote the formation of mncns P 
Let ns take the instance of common salt. Chloride of sodinm is 
a targe constituent of mncns, and salt, when taken into the system, 
probably promotes the production of those secretions of which it 
forms a large part. It is, indeed, a food to tho mncoos membranes. 
This sngg«stive hypotheBis may possibly apply in the case of other 
members of thia group. These substances, especially sal ammoniac, 
are sometimes employed in catarrhal conditions of the intestines, to 
prevent the formation of that thick tenacious mucus which forma 
a convenient nidus for the various worms infesting this canal. 

Dr. Rutherford's experiments with fasting dogs lead him to the 
conclusion that common salt very slightly increases tho secretion of 
bile. 

Owing to their high diffusion -power, these salts pass rapidly into 
the blood, and so travel along the intestines too small a distance to 
act as purgatives; hence, unless administered in considerable quan- 
tity, they exert very little inflnenco on the character of the motions. 

Common salt is used to produce sickness, or to promote the action 
of other emetics. Given in poisoning by nitrate of silver it effects 
a double decomposition, precipitating the silver as the harmless 
insoluble chloride. 

Chloride of ammonium is often given with considerable success 
in chronic catarrhs of the bronchial, intestinal, and urinary mucous 
membrane. It is indicated in bronchitis when tho secretion is thick 
and abundant, and it may be applied topically to the morbid mucons 
membrane of the respiratory tract by the atomizer. It should be 
given in twenty -grain doses every three or four hours, adding it to 
milk ; or, still better, mixing a drachm of liqnid extract of liquorice 
with each dose, and thus concealing its disagreeable taste. It is 
recommended in catarrhal jaundice. It certainly appears to be very 
useful in tho congestive stage of cirrhosis. 

The same remedy has been lauded for whooping-cough. It is 
said to be frequently successful in removing tho pain of facial 
neuralgia "of rheumatic character." It should bo given in half- 
drachm doses, and if, says Sir T. Watson, four doses fail to give 
relief, the drug may bo considered unsuitable for the case. In full 
doses, several times a day, I have many times found it useful in 
facial neuralgia. Dr. Anstie speaks well of it in migraine, clavus, 
myalgia, intercostal and hepatic neuralgia, and in mild forms of 
sciatica. 

Slany doctors employ this salt in a!! forms of neuralgia ; and I 
have heard some eminently practical men go so far as to assert 
that in thia painful affection they require no new remedy, since 



S18 



SULFBATKS. 



4^oride of nmmoninm no mraljr fails. Chloride of unmoniain is 
largely aawl in India for oougcstiou of the liver. 

Chloride of animoniDin >s givon with ndvAniiig« in kmdachos dao 
to menorrhogifl, aiiiciiorrlitf&, &c. 

Commou khH KomctiTnce nmiMU hmnoptj«iK. Haifa t«as]iDOnfiil 
should be utken undisiolved, aod be repeated oocasionallj- till it 
cxcitfls naajK*. 

Dr. Parkea sUtos that " moriate of ammonia is not oxj-dizod, bat 
pa«scB oat nncbtknged by tbo urine." " According to I)»:lcer, it 
incrautGS (in health) all the constitaeots of the urine, exoopb the 
aric acid, which it slightly diminishes. The moMi daily incKkw 
of the area in thcao experimonta vras 4-793 gframinaB, or 74 grsiiu, 
an lunonnt which indicntos n viut ntignifiitiition of nnytamorpliaaifa 
orof elimination. The volatile (talta and extractires were inarcMed 
by no leaa than 18*96^ gramniM, or SdSgnun*, which was, no donbt, 
partly owing to tlto prcHunoo of the rolatile chloride of antmoniiini." 
(Parkeeoit Urine.) 



Qraap conlainiii(c SULPHATE OP POTASH, SULPHATK OF 
SODA, 8ULPHATK OF MAGNESIA, PHOSPIUVTE OF 
SOUA, TARTRATE OF POTASH, BITARTRATK OF 
POTASH, TAKTRATK OF POTASH ATiD SODA. 

We have adopted this gTonping, with slight modiflcatton from 
Bnohhoim's oxoellont work on tfaera[H.'titiai^ 

With the exception of the snlphato and bitortnlo of potash, th«M 
mIntancM are freely solablo in water. 

The salpbates hare a tct)- diBs^TMablo Utter taste, which En th» 
pbucphDUi of soda in but Hli(;bt, and in the tartrates ia abtient. 

I'hey aro all parj^tire, produciut; watoty ovaonations, wluoh ia 
probably dae to thoir very ton- diSnaion-powcr. 

They have little or no affinity for aaimal texturoa, or mnoh attnu'- 
timt for w«t4'r, wbonoe they cffeoi few ofaangoa in the oiguiia «aa- 
ttitoeiits of thu body. 

While they all act as pnrgativeii, producitig watery evaonatiotiii. 
thoy oxoito very lillle trrilatiun in the u)iu.-os8 nembtsno. 

How do Ibey prodnoe their |>urg*tive «ffoolP 

Pnrfcntlvra may aot in nnn uf two witjK, or in Ixitb combined. 

Soiite piir;^' by imrrvsjiing tlii< nioiMtnro of the intestines, anil ao 
facililnlin(( the paMo^o of the oontentH alon^r Iho canal ; othoni act 
by tnoreiuing lli« poristaltic action of tha intMlince, so that Uw oob> 



SULFHATB9. 



219 






tents are urged more Tapid]y townrda Uie rectum ; whilst, moat 
pnrgtttirofl combioo both modes, nlthongh oaa action usually pro- 
clominates. 

Tlio watsry chKntcter of the motions shoivii wiUionl dnnbt tliat, 
tu part at least, theire clra^-« ]iur^! bj augmenting tlio moidtun: of 
tiu) coatcnts of tho inffstiiice — an angmcutation vSootcd in tlirvo 
ways: bj' causing water to Sow from tli« Mood into tlio intcatines; 
by oxoiting tlio mnooiis glnnda of tliU tract lo inoroiunl secrotion ; 
or by efEecting tbo retciitiun t>f tito wnter alruody present in tlio in- 
testines. Bui^bhcim concludes from his careful ohncrvnlions, that 
theao salts puige solely in virtue of their power to retain in tbe in- 
testines the water existing there, prodncing no Bow of fluid from the 
blood, no increased Becmlion from tho mucous glands, shown by the 
fact that, after purgation with these modicinos, no aJhuminous eiib- 
atanccs are foand in the ftece*. 

In an elaboiuto and valuable paper. Dr. Matthew Haj luut nv 
iBveBtagated the mod*) by which aaline cathartics act. His experi- 
ments sltow that salino paigatires act by exciting an increased 
secretion from the mncoos morabmne, ehieflj of the small iatmtiuf, 
and the incrpikso in tho contents of the intestinnJ canal is not due to 
an increased pancreatic or biliary secretion. This increase in tho 
quantity of fluid in the mtestino is a tmo sccrvtion, and not due 
to inllunmatory irritation nor to osmosis, for tho intestines are not 
cODgestedf and tho fluid in tho intestines only contains a trace of 
albumen, and the quantity of fluid tu tbo intestines a short time 
after the administration of tlio ealinr, compared with tbo quantity 
of salt absorbed, is tar too large to be explained by osmosis. 

The nline poiavs rapidly along tins nnall iutvstino to tJie colon, 
and almost tlw whole of iho floid rea.oheti the colon of a fasting 
animal in an honr. Food probably delays the pasntgo of the fluid, 
luid eo weakens the porgatire action. 

The aalinu is absorbed by the Kmnll intcHtinc, but oicrotcd by tlic 
colon, hence wlulst tbe fluid is in largest quantity in the small 
intestine and becomes rather Icm as the contents pass downwards, 
tho salt is less in the small intestines, and is in larger quantity in 
the colon. The purgative action is not, however, caused by the 
secrcliou of the saline by the colon, for, whoit injected into a rein, 
anlpfaate of soda and sulphate of magnesia do not pnrgc- 

Ue finds the absorption of these salts very slow from tjie eiorancli, 
but rapid in tJio small int«stinc«. 

UngiKBiau snlplato he fluda much more ))aisonoas to the respimtory 
centra and tbo heart when injected into > rein than sodium sulphate. 

Thiry and Bodsiejewski conclude tliat tlteso salts and other purga- 
tives act bj iacnaaiDg the poristaltio action, espeoiolly of the largo 



220 



erLTHATSS. 



iDlAitino^ BrunUm baasbown tWtaBotntifln of sntptiata of tuBgoosJ^ 
doM tmaat Rstd to paaa from tli« Mood to tlie inlestine, for, wlun fl 
•olntioD of Holpbate of nwgiKina is pnt into n knttcklo of intcrtoH 
aMored at both endB, it is fonad tint afu-r iscime Uoan the coatenfl 
of tbo bug nra tooreucd, and t)i« question arisM wbnllicr thin aa^ 
mentatiou is dne, acoording to the old %'i«ir, to simple osntosifi froia 
titt blood, or in dnc, aa Bmnton tliinks, to stunnlation of tho raacoa* 
meml>mn« of tlic intMtinc. Wli«n iru bear in mind how an imtaat 
liko enaR or pepper nppliod to the now and<7Gacaaw«a oopion* flow 
from theae parta, w<! din easily conocive that Btimulatioo will caaso 
a copioas outpour into the intestiDC. Alorian has shown that soction 
of the inUrrtinal nerves canncs a tree serona exodataon into the int«B- 
tino. bot it does not appear tliat paraljr sis of them Borvea oxplams tho 
p«]pliv<i action of siUtnca. Tho KtooU prorolced bj soliiMS do not 
contain atbumen, as thej would wervtho excess of water thqr contain 
dno to KcroD* exudation. 

An excellent way to adminietar some of tliom salts is in the form 
o( Pallna, Priadricluitiitll, or ]>crfaa]M, best of all, .^citlap water, in 
doaoe rarjing from a vrinc-gtiiMfal to half a tnmblorfal or more. 
UBaalljr onedosolxvforo bronkfast isaufflcieat; if not, aaecond. and 
ev«n a tliinl, doM maj b« taken to lh« conrso of tbo day. It is ad- 
visnlilc to mix tlia natond wat«r with a third, or an e4|aa3 quiuititj of 
Inttin^ wat«r ', (or when taken cold, it is aomotimcii Hnblo to "li« 
henry on tbo atonuch." Ctmallj' a wino-gtaasfnl of ono of throe 
watom, with an vqna] quantity of hot wntor. is raflkiont to op«a tha 
bowels williont mui-h ^pintT or ptiu. 

A winc-)^'ln«<rnl of Frie<lri«hsluill water in a break fast-cupful of 
liot water is vety nscfnl in biliouM Hiek headacho. TIic licet tintu ta 
boforv breakfast, Uiuut^li it is ii»ful at any tim«. It stays tlio anoaea 
and toon reliove* tho hvadnckc, Muaetimua without pnr^njr. Tho 
taste nf tilts miitnru is not Tvry disagrveablB. Pallna or Krii-dricb- 
Hhall wator inixiHl with milk ia a good pnr^tivo for chiKlrun, tho 
milk disguising tbr> bittomeas. 

An onn|i(i> or two iwton bcforo bmtkfact is ti pleasant and oftoa 
dfcotnni way of overcoming nwdornt* hnlnlnal conxlipHlion ; and 
■pniotimen, imlmtl, this plan (ircrcoram ihe moat iilialinat« forma. 
Another good nicnti<i of oIiviivti:ig constipation is to take a glaaa 
of cold water b«fon>, and un onn;^ aoon afttM-, brtvkfast, and if 
otwigaa bflfotv t>Rnkfiui duagreo, thuy should b» taken won nftor iu 

HtAWod rliubarl»,or BlcwedfCOosehcrruts.oookudoruiM-ooki-il Hpiilua, 
nn dtttUtniMl I gmpoa and alrawbarnaa, on tho other hand, aro ofion 
luolaH. Slraufle to say, wo ocoa^onally meet with people in whom 
fruit CKnans cnnstiimtion. Again, we mo indiriilual |K«nliarititM 
in rus|ieot nf fruit- Thut, aome are made bilioua by omngei or 



StTLrilATE!. 



221 



I 

■ 

I 



strnwbcrricB ; some are constiptttcd by atmwborrioB, wliUst other frnit 
relaxes. 

Tli«rc ate nutny pcnons, especially busy, worried men whosB 
comfort and weil-lwing eeora to (K^ppnil on an vHic-icnt daily waco. 
ation of Uiu bowels. If tbej paaa a day without nVtbt of Lho 
bowels* or if the ttefocation is dvlaytnl to tbo aft«r part of tbo dity, 
tboy Kolfer from mirnta] diilnoaa aiid inactivity, a kind of fog^eaH, 
with much irritability, and pcrhap* a dull, "ilnpid" boadnclie. 
Tlifiy aru ([oito oausciotia of their irritability, but cannot woU con- 
trol it. Diroctly the bowfds art frwdy, tUtso Kymi)toni8 vanish at 
onco, the head cluarn, the spirit* revive, the ill-tonipor diaappoarK, 
they recover their fall mcntnl capacity, and in a sliort time longer, 
perhapK half an hour or an hour, the headache diaappcars. With 
many snoh patients tlu constipation ia not obictinato, but tlifv pa«o 
daily a hardened, drf evaooation, insnfBcient to give comfort. 
I'orridge, brown bread, and oxorciwc aru generally suRicicnt to over- 
oome the oon&tipation. If not, then fruit before or after lurealtfant 
should bo triod, and this failing, the natural pnrgativo waters will 
often prove useful. 

Carlsbad waters aro eminently niofol in many abdominal diEenaea. 
The imported waters are espeoially elBGaoioaa when a dietary ia 
nilopted Bimilar to that enjoined at Carlsbad. The water should be 
warmed to abont 100* to 110', and tlie patient mu&t dritik three to 
six tamblorfuls before breakfiuit, prolonging tin- drinking ovlt an 
honror more, and if possible, whilHt taking excrciao in the open nir. 
Dr. Stephen Ward nays, " Even when first lakon, and in moderate 
qnantity, they usually cause pulpy slimy stools of dark oelour and 
offensive odour. These stool.t arc generally frcqncnUy ropcalwl, 
and tile patient ia aatoniAlied at the quantity that eometimeit crimen 
avay, but in many portons no very evident symptomg bej-ond the pur- 
gative action attend the drinking of the watora." I bare nircly suca 
them purge, because, perhaps, 1 have chiefly used them in obstinate 
consti])ation. The <iuautilr to bo taken depends on tlieir electa. Itia 
better to begin with throe tRmblcrfuU and gradaolly increase the 
i|aantity to four, five, or six. accorvting to the action. Thin treutmout 
must be continued thrc« weeks or a month. It often induces some 
weakness. It reduces stontneas, and eomotimea even makcH a patient 
Tory thin. Unt if it ]>rodueo much dqircwoR, or excite norroDS 
symptoma, a smaller quantity mnal bo taken, and the counte must bo 
limited to a fortnight or thr«u weeks. The geuil efTcctn arc i>omo- 
times not apparent till a week or ao after the course The diet at 
Carlsbad is oxtrcmoly simple. " Pat, butter, cream, poatty, elieean, 
rich mealai, sm pork, goo^e, sansogoe, salmoo, mackerel, herringa, 
anchones, entrees, nud other dishes s»soned with spices, popper, 



222 



SFLFBITRS. 



onioos, gKrlic, Ac:, are to be avoided. Diveeed sftUds, micuuber, and 
uncooked trait gcncndly nre objected to wi Iwiog indigmtibh), tnaA 
Itk«Iy tA cause flAtaJeoce, »iid irritation of tho bowok. The use of 
spirit* is nlwolnt«ly foririddcn, wul tlio wi&a ot tlmconntiy, or tha 
ligbt«r Kreucli wines are permitted only eparini^ly, and in cmm 
capociftltjr roqniring n ccTtnin nmonnt of gitimaln*. Tho brodlcfast, 
vbtob is usuoilf taken about an hoar after drinking the laat cnp of 
iratcr, coDsigts morol; of weftk tea or ooffee, with laitk and a littlo 
tfogta, and BBiaU wetl>bnked roUs, or eecood day's bread ; oMat, 6ah, 
or oggB being oxclnded, oxcpptfor the Tpry dctScatc. The diniwr, 
which takce place at one, consists of bnt thrvo courses ; son|>, free 
from grcneoandspicce, and thickened with barley, rice, or ronn jcalli i 
meat, aa heef, nntton, lamb, jwultry, or game, vrith wcll-botled, fresh 
TO^tablea; and a tight, sin]|ilc pu Jditif;. oraconip^tc of »t«wod frait : 
a cap of coffee may be taken in tho afternoon ; a light snpper b taken 
at eight o'clock ; and smoking in ntodcntion is not objcct«d to." 
(Dr. Stephen Ward.) 

This treatment iii extremely oCefnl in obstinate habitual consti]; 
tion, and by its moons I have onred some of the most rebelHouB < 
In such instanooB it inay not relieve the bowitls for some days, indeed 
even a week may pass withont relief; in other casesit atoamprodncet 
onoor two eoft^ oopiuoK, natural eracnations, and on disoontinnin^ tha 
water, the bowels act daily. After wnui montlis, kowercr, a i ~ 

to tho waters may again becomo nooeasaiT-, owing, genorally, to aoi 
fault in the patient's hatiit«. In cases of simple, obstinate eonxliin. 
tion, it is not necessary to enforce very iitrictly the rigorous Oarbbad 
ngtmon jnst desoribed. 

Agaiu, in cases tike tho following, Carlsbad waters aro very nsofnl : 
— A middle-aged woman, accnstomed to eat and drink nomewbat loo 
freoly, snlTots from acidity, much flatnlenoe^ constipatioD wjth 
attadcs of pain at the epigastrium, or over the liver, or betwvcn tlw 
dionldara, tb« oonjanotiva Iwcomin;; nithor jauodioed, and tho c<Mn> 
plexioB sallow. In a case tike tltis, a wolUregnlatcd diet greatly 
awi«t« the action of the watcn. Tht* tratlueni is also very nsdfBl 
in galUstones and gont. It is the moat snocesaful treatment for tho 
ramoval of gntl-slones, and the jntrvnition of their farmatlon. 
l*Btienls BomettoM lay they have tried Carlahiul waters wiihotil good 
resatta, when they have nirnply taken Carlshatl xalta diwolriNl tii a 
small qnanlity of water. In snch a form the Glanber salt* par|{w, 
bnt (ail to yield the mme exeollent rainlts, as when given Urgely 
diltited with walvr; I have do donbt that the Urge balk ol water 
plays a |iromineDt ]iart in the tbenjientio eCccts. 

The medioinos now under euDHideration are not lo hn indincriiiii- 
nately obkI. I3itartrato of potash is employed in botli geaonl and 



SULniJ,TIIS. 



I 



load dropBica, but more frcqiiontly iu gnEteral dropeies. and la 
eepccinlly iiKi'd an n livdmgcgiii! ciithartto in Bri^ht'K disciuc, t» 
imrunt daiii;crou!t water/ accumulation in tbo c«)]al&r tissual, or in 
tha nritiCH containing the haai and Inn^. VfMi tlic via.bet, it 
draws off also Die dfet« and poisonous luattora wkicli in this dinooeo 
aro contained in tlio l>lood. If ntcro uvacoanU of llic intostinea, 
tliese ramedit^ mij,'Iit bo thought in«IIectiial to withdraw either wnl«r 
or RToa from the ej-etcm ; but a littlu reflection will ahow cm this ia 
not the case. 

During digcKtion a comtidenblo qaantitj of Hnld ii* ponred into 
the intfistinea by the stomach, the liver, nnd the pancreaa. Now, if 
tho blood contiiinit poisonous mnttom, xomo portion of the poiaon 
most conttuuinato the flnids socretod by theso OTgaos. Xty rctuning 
in tba crdaI mach of this fluid, until it nndergoca expnision throngli 
the anua, these mediulnes diminish the quantity of flaid of tlio body, 
rcmoring simaltnnooniOy sono of the poisonous nwttors accumulated 
in it. So far theury ; and experience, we find, nupi^orts it. The 
concurrent testimony of practical men, boars witness bo the fact that 
free purging witli bitArtrute of potash, or by other mcmboni of this 
group, lessens the fluid in the cellular tissue and carities of the body, 
whilo it often simnltAnt.'ously removes comn, oonTulHions, and other 
aymptonui due to the poisoned blood. It is a treatment that must 
be adopted with oaution; for it must bo borne in miiul that tree 
purging is weakening. 

A brisk purgative frequently promotes frou and abundant secretion 
from the kidneys, either when healthy or diseased; niid hprcin we 
haro, perhaps, fnrtlier elnuidation of thu good eEFocts of these rem<s 
dies in Bnght s disoaso. 

&itne KK^tnhcr of Ihiai 'group, guni-ndly either sulpbate of m&gnesia 
or phosphiitt; of kkIu, ih nlteu priren oa an iuleMinal evucniuit in Eoror; 
Iteuce they are n>pnt«d to bo fcbrifagv. But Ihoir action ia due 
■implj to the unlomUng of the bowels, since it is well known that 
constijialioti augments tho protomatural foror boat. 

For forvr patients, Dr. Anui>lii>ng stroi^ly recommended free 
pargotion. to the extent of several ovoonationH daily, during the lint 
few days, Ixjfoi-o exhaustion sets in. This treatment still finds just 
farour with many practical aathorities, althongh it is doc approved 
by Dr. Qraroe. It is considerMl that five purgation in scarlet fever 
prevents severe eoro-throat, glandular swellings, discbargcs from the 
noae and cam, with many other diaagreeablo sequeln'. 

In nuMwlcc, purgatives must be given with cantiou, the bowels being 
generally irritable, and diarrb<xa often present. 

TlHisaltauf this gronp most frequently employed, are tho bitartiote 
of potMb, eolpbate of nrn gncaia, and phospbat« of soda. This phos> 




S24 



SDLPBATES. 



pbnto, woD-nigh tutolMti may bo gpron, nRKQ»pcctcd, in a liUl9 
brotli, to chiklren. 

Tbo mipluitc* KIT connnon tn^redtentii in |iiirgntiv« luUank] irat^rs, 
uid in tbia TDnii am fivqaentlj' Ukon in small (lows in conittiputitm 
cir torpii) liver. In oliftiniiln cDnstipiition, n rlrati^bt shonld be Ulcen 
onoe or twice daily. Small iloeoe, often rppmlfHl, act with invntor 
peirtiun^thui asinglit luf^doae; Iwnve, nlwn Ibv bowolsftre tightly 
locked ap, ksving reaistcd tbe action of n fiil) dosi> of K|)<tom tutlt, it 
is a good |Mttotico to ^vc tJic nmo rvmoJjr in small and uftuii- 
repoUed qnantiliea. 

It Bhonld bo mentioned tbat iialphate o( pota^b shonld be givm 
witfa Bome oftntJon, for, althon^h luaallj s mfv and mild pargatiw. 
it hu prored in some caaea poiaononfi. 

Bntlutrfbrd, from hiit expOTimenta wtlli fnniiDic dngs, finda that 
pboapfaatv of aoda ia a jMwvrfnl cbotagY>guD, not mcrelj' emptjiny tbo 
g»lI-Uaddcr and biliarjr dact«>, tho&^'h a^itnall; increaaii^ the MCtO> 
tjon of bite. Salphat« of polaab and Rochelle salts ho finds moderate 
oholigagnea, whilst rolphato of ttodn i* onlf a foeble hepatic Htiiiinliuil. 
Stnuigc to my, hu finda that KQlphatc of magnesia prodDOCH no fffcct 
on the liver. It is interesting to observe, that sulphate of sodn i« tbo 
chief in^^redient in CarialMd water, no Urgcl;- iiMd for ita aetton on 
tbo lirer. 

Dr. Bartholoir apcaVs hi)i;)ily of phovplmtc of aoda in raturrbal 
jaundice ; a dracbm ihnx' limes a day to adnlle, ten grains for 
ehiklren. He oenunnda it also in hupativ csolic, to prevent the 
teniation of gall-atonea. In biliary colic the treatment should be 
persisted in for nercral months. He aim strongly recomraendH ten 
gntinH MTcml timM a dhj in milk for ill-conditioned children, paaeing 
{laslj' vrhite stools. 

On aocoant of the low dilfiuion-powor of tJieso Ball«, very littla 
|MMSw into the btood, the greater pan, especially when tliej' ]>nr}^, 
pMMing from the system with the ftPcn. Small doees, if tliry terry 
long in the inttrntinen, ultimately pose into the hlood, mud are wvpn- 
mteilbytbo kidneys, 'fliny are rcpnted to act as diuretics. The 
tartrates of this fcranp are highly ealoomed «a excellent diuretica in 
Briglit's dianoMi, and are often employed in doses tiliort cf purginif. 
Tile tartrates and liilartmtes are crmvorled into i-arbunatea. partly 
in the iiilestine*. and liartty in tlie blood. I'hry thus lessen tb« 
ncUlity of the nriae, orevvn render it alkaline. Except in the cajw 
uf pho*pba(e of aoda. the action of these salt* on the constitneala 
of the urine, either in health or diseue, has net yol been worlwd 
out. 

As the action of pbosi>hatc of toda and of phoRi>}innc oeiil nppiiuv 
to be nearly identical, wv will speak of them conjointly ; and fur tba 



MTKATSS. 825 

aoeonntof Uieir Mtion, wo niuHl bo inil<.ib(?<I to Dr. Pftrkes' cImbim] 
work on iho nrino. 

It Bwker's «x})erimentii on liis awn penon nro tn bo nccoptctl kh 
cwnclasivtf, tlio cffocU of thcao snbstanoea lire highly oini^lar. He 
(oonil Umt |>bos|>bori(.- ncid rUwa^H cnrnod jicitiiKli out with it, and 
that phosphato of soda clmngc<l it« befic, taking potash in its place. 

Pbospbate of itoda, Uieruforo, (neatly lesaena tbe qtumtitj of polMih 
in tli« body, and the acid woaM greatly diminieh the amount of 
iitkali in the blood, bat for the eingnlar fact observed by BSckur, that, 
while etiminatiogpotasli, both phnnpfaorioncidand phospliate of aodik 
CAUDcd a retention of i-hloridc of sodium in the blood, to each ft 
degree nsactnally to heighten tJie alkalinity of ibo body. 

The cifccl of j>hu«phate of soda is to leaten the ureK in the nrine, 
partly by tlio retarding effn-t it oxcroisos on digOBtioo, eo limitini^ 
iheaupiilyof food to the system, nnd oouaequeutJy dimini«htng the 
quantity of tin» MpArated by tli« kidneys. But it appears that 
tbu diininntion is dne in part to leasened metsmorpliosJH of timne, 
nnce, even wlicn thv khH in given on an empty stomaoh, the nreft in 
tftill dimivi-thed. PhospUoric acid neither lessens the unia, nor affects 
I the digeatton. 




KITHATE OF POTASH, NlTltATK OF SODA. 

-» Toiy high diftnaion-power, ium] are frwiy 
wilublu in water. Tlioy lonur the tempentora of water, «& eSeot 
very coasidurably iiicntaMx] if *>al luniDoiuaa is mixed with tlie 

'nitiD. This combination of aalta nited to bo applied to tlio skin 
ns a rcfrigrnitor, though now it is mraly so employed, and is to 
1)0 especially avoided if tbe ikin is broken, u ooIutioDS of Uio nitmto 
aro T«ry irritoliog to tlw wonnds. Ice u in ovetr way a better 

^ rofrigerator. 

Tlie inhalation of tlie fames of burnt nitre paper will somctimM 

[Brert tbe pquoxysm of asthma. According to Dr. Uydo Snlt«r tliis 

I treatment is most effectiml in pnro uncompUcatod asthma. Ho 
points out that tho paper uiiist not imbibo too mach nor too little 
nitro. If the bibulous pajwr is too thin, it abserba inaaSioieat nitn; 
if too tliick, it takes up eiceM of nitre, and the fomas ore too ti»f 
bottocwxiH, llie |injwr burning^ too fiutt, with a sudden explwiv* 
flame. There should bo no brown smoke, but cloar wltite funMS. 
Red blotting paper of moderate thickness and loose taxtaro is 
best. Dr. Salter gives Hie following directions for the mannfac* 
II tare of niir«'|iupur : — Dissolve four ooncoa of nitro iu half a piul of 

^ 



1 
t 

I 



226 



X1TBJITB8. 



boilinfir wat«r: ponv tho liqaid into u nmull rnnitcr, And sonk the 
]ini>er, tlicn drain nnd dr]- it. Cut in intA pioces four inclios sqnare. 
when nrqairrd, bum ono or t«ro of tbc*o picoM, or a pi«» 
ny be burnt nightly in tbe bedroom. The prepared paper noat 
bo kept in a dr}' pinco. In tlu> Pl^Arraiuiopcfiin of linn TtuyxU Hiu. 
pituL Ur. Morell llackenxie gives tba prvpuntion of t-hree papers 
of dlEForeat etrongth ; odd outAtt fnnn a Ralntaon ('nntaining ■istj' 
graiiiSt another fortjr fp^ains. nod tho third thirty ^rainii of nitra to 
an oitnco of irntor. Ho dirocU tbu ]Mpei- to Itv cat into pieoM 
three inches long and hnlf nn inch bmiul, and ono to six of tfaiai- 
piooeM to be dmmI tmooeaaivolj at oach inliidation. Tlie iwpM* h 
bamod in a jar, and the fumes inhatod by taking dwp inspiratioiia 
fmni thu fnroinf^ tuaw.)!. Varions KnUttannrH may be nddad to thi> 
solution which appcnr in sonie inalanoeB to hoi^bten the eAwt of llui 
nitrv^ Knob tut compoand tinrtnm of Iwnzoiu, iipirito of camphor, 
oil of cassia, and t inctuiv of eanibni. It is a singular circumstaow, 
affording a marked ■•minplc of tho " enprioo " of attthmii, that a 
poipor preparod with nitre only will relieve one pationi, yet will 
ntiurl}' fail to relievo anotbiT, althon^b a nitru pa]»-r prupan-d in 
a diffurcnt niannur may bo <]uite successful. It must bo borue ia 
mind, therefore, lliat allhongh one kind of nitre paper baa failMt, it 
doot not nooowinrily follow that another Kori of nitre paper will 
atao fitil. Sometimeti a thiu pnpcn- fails where a thick one tiBocveds. 
or rMv rertd. It appears, Indeed, that rciy slight diSorencwa in lb* 
modo of manufacture inHacnce tbe tlicrnpcutio effecia. &Iany quack 
]iapors (aid to contain other sniHtanccs besidos nit»^ or boei<le« aitm 
and chlorato of potash, often iraccced adiuirablj. 

A oooMidentble recent experience IcaiU m« to oaoelnde tJiat Um* 
papm would prore much moro relieving if nroowliat differently pt»> 
panxl, and if piocca wero bttmcd tullioiontly large to Kll tlw room 
with (omBf. The most cflicactouH {taper is made by di]>ptng ordtnary 
wUil« blotting paper in a boiling ntutuUHl imlation of nitrate of 
jiolouli and clilontlu of potaith. Paiier llina prejnnxl baniH with a 
Unme. A tai^ piece, the sixe of connw depending on the dirocniioiu 
of tba nam, often vuccvuda when other preparpil |inpers fail, 
pjooatm rnohcs nqnan-, and somctimM two or thnv piecta araiv^ 
qnind. When ordinary japen have failed, 1 have rocvntly bm4 ia' 
aonM cases with ndvantSfre a pantile eompncndrd of two pniis of nitn', 
tmo pari' of (■hlomtt) of putaah, witJi two pads of lycopodiiuii [towdcr. 
My friend. Mr. William Murrell, is naing with mnoh snoecaa a tbiclc 
paper wakKd in a boiling satarnted solntiou of nitre and ehJontto V. 
pobi^. 'n>i« lhi"k paper, mado by tho adbntnn of tan sheeta dtai 
cryalallitalion, mntniiui, when dry, twicv lis own winght of salt, aiwl 
a pwc« of t^per six Juchvs K|uarv, takes op nearly half an ounee at 



1 



I 



SITRiTKS. 



227 



I 

I 



I 



tho mixed snlt. Cortnin cnms roquira n grait«r qnAntitf of nitre 
Bmoke tlian oUiere. I am convinced thnt Uis rontton vthy papora n\t- 
pair in m many cimpn to fnil, ih tlmt they nrc not ndoqantelf im- 
prcKT^aled witb nitre, and art* oonaumed too njnirin^'lj. 

Thn crystuU nf nttiv huvo a cooling wltna tMito, and in acutfi 
inflaiamation of the Ihroatmre eoroetimca BTioked, but utUor rumediw 
an! ])refcrnbli\ 

These salts, it U tlinuglit. while underKOiiig solution id the stoiaacli, 
will absorb boat, and (■mil tbiH oif^ ; but to l>o of any oorricv in thin 
way a sufDciont qnantity cannot bo taken witli safety, ioo or ioed 
water in ftir mors <JTe(!tnal. 

In large doaos tLo nitrates indamo the elomacb. LVea wbeii taken 
(or somi- time in uiodemt« quantitiots lliey coiiaideKbly dixunlvr 
digestion, prodncing nauBf^a, voinitin^, and a coatod toDgna; consv- 
qnentlj- tbeir action most bo carefully watc-bid. 

Uow tho nittntca oxoito inflnmination of the skin or Mtomaoh is not 
yci explained ; tor, if these tisniea ara aoakotl in solutions of tliesv 
mite, no other chnngc takes pinoo than occurs from the action of 
simple water. 

From tbdr high difTnKi[:in> power thow salbi spoodily cat«r the oir- 
oolatiion. Unleu, indeed, lar^ quantities are taken, they posit bat a 
«hort way along tho tntostine*, and, tborefore, do not purge, and, 
indeed, so far as we know at present, exert little or no direct inlluetK-e 
on «ither tho small or largv inteatinM. 

iUuoh conjecture liaa been liaxnrdcd rogarding lUe action of tho 
nitrates on tlio blood. It in well known tliiit ihuy prevent thu ootigu- 
lation of the fibrin iu blood withdrawn from the body, or, when 
ooapilated, dissolve it. . Sduirer, howeror, aasvrts that thcry will not 
dtasolre the fibrin of inflammatory bbod. Thcee fact« have led tu 
tho supptnition that tbu nitntiiK may ptiMtuMii a lik» induencu over 
llbrin in the oircnlation, and tlutt they are indicated whon this sub- 
Htancit is in excess, as in inflnromatlomi and ocuto rlicnmatiKm. There iit 
no proof, however, tliat the nitrates possess any imch power ; and, in- 
dood, nnlcss employed in oonsiderahle qnantitice, tbr^ vsert very 
litlJe inflnenoe npon Sbrin ont of the body. Elcncc it cannot be ex* 
pectod that after itx dilution witti the tluidH of the otreulution, lianR* 
less doses can in any way influence the fibrin of tho blood. Bat> 
indeed, tbiit notiini ih no Ioniser tiiinbUt ; for it has btn'ii iu:(!ertiiinftd 
tliat blood witbdi'swn bxna the l)ody, both before and after the ad- 
miniictnition of nitrate of polasb, contains in each coso tho samp 
quikntity of filnin. 

Tbeso salttt am eonsideMMl to be highly uscfnl in ucutc rheumatism, 
and are supposed to protect tho valvesof the heart, or to restoiv thrin 
to their natural state when damaged by rlioaroatiun— a truppoeition 

42 



228 



KITUTKS. 



founded on « mimppTrhciiiiion of tlifi morbul proceawB triiioh loud to 
YklvulAr ixmtraction and incompistencf. Those struct ami cliongeSf tt 
miM imngincd, nrKallod from tlio di;])o«iti»nii of fibrin oii tlir Mirfaoo 
of the Tftlves, and ihe enbseqnont contiwtion of this onbetAneo mo* 
(IctkI tlutm HlininVcn luiit inufficinnt, llii! truth being thai t]>MU 
chuigce in tho tdIvm kto owing lo lymph formud in thoir own snb- 
•tADce. Ocouionally, it is ti-ui>, fibrin is d«|>oiiiiod on Lliic-keDtxI moA 
ronghanod ndvoa. but evtia thiN, us Iih jnst bwn pointed ont. tli«ee 
i^ta can neithflr prerent nor i-emove. 

Whilo it RiBst ho lulniittRd tbnt tiwiae salts do not »ct in tbo way 
iippo«e<l. many bi|;b aulhoritiea ooiisid«r that nitro mitig*t4iH nod 
hortons an ntt»ck of rboonwtisD]. The adToatos of nitre ad- 
"iniiiisler it i:i large doses, fr«ely dilnted in water, K<*'i'ig as mnch 
an lialf an ounci- to an ounce of tJiu salt in tlio conrse of tbe daj 
in bmonade or barley-w'ater agrocably sweetened. The urino, it ia 
said, becoQtcs rorj- abundant when tiw fcror dwlinos, and the paiu 
abate. At present tbero are no observations snIBciently exact to 
dctorminP thin point. 

The aame discrepancies of opinion pn>vail re{pmlinf( the inflaoMM 
of the nitrates on ucate inftammation. 

Large doses ptyidnce pninn in the stomocli, willi voDiiting and diai^ 
rii<ea, RTCftt woAknoBB, faintings, Iom of oonscjonsness, and doatli. 
Tbo enmc symptomB art: witncMod in a minor degree, whim Toss im- 
modetBlt' (juantiiira are used. Tha patient becomes lan^^d, dia- 
inclinod to emrt either body or mind, and tlie |mLKi U feeble and 
ttloir. 

These salts readily pass from the body throogb the kidneys with 
the urine, and in their paeaago may irritate and inflame tbe urinary 
organs, and in large dotwii may even prodnoe bloody urine. 

Kitfate of potash lias becoi recomnwndod to tlio inooutinencv of 
nrinc of children. 

The nilmiw api>ear to increase teoiporarily the water and nrM 
of Uio urine ; nltimalely, liowevor, these Imtli fait helow their 
nnlnral amount ; luaoe the oitratea an mere eltmioatom cif tlu^ 
■nhetaooos. 

In some (inarters they enjoy a very high repnlation as dinrotiHiv 
and in certain casea ap|>ear lo bo of conaidenhle ecrv-ice. Th«tr 
diaretjo action ia wdl ditplayod in lumbago and chronic rhetusa. 
tiun ; accomjAniod by scanty high-coloured urino, which beonnoa 
titrbiil on cooling. Ten grains of tlie suit dinwlTod in water, takoa 
bunriy or every two boors, in roust cases will soon tnereaae the arina, 
randering it olear and liot|iid, when the rhofiBiatio ftia. 
decline. 



CHLORATB OP POTARB. WS 



CHLORATE OP POTASH. 

In masy of its chemical properties Chlorate of Potasb coireaponds 
to the preceding group of nitrates ; like thorn, endowed with a high 
difFnsion -power, it differs is its sparing solnbtlitj^. 

A solntion of the chlorate, used as a wash, is said to clean and 
Btimalate fonl ulcers ; bat other remedies are more eEfecttve 

This salt appears to increase the flow of the Baliva, and, according 
to Hutchinson and others, to produce ulceration of the mucous mem- 
brane of the mouth. It is largely used ia varions afTections of the 
mouth, and is of signal service in mercurial and aimple salivation, in 
ulcerative stomatitis and aphthte. It is particularly useful in the ul. 
ceration of the edges of the gums, generally limited to one side of the 
month, affecting both the upper and tower jawB, also that part of the 
tongue and cheeks coming in contact with the ulcerated gnms. Al 
though not at all dangerous, it is often a very obstinate complaint, 
especially with odnlts, though children are most prone to it. The in> 
fiuence of the chlorate on this form of ulceration is almost magical ; 
in one or two days it cleans the dirty-looking ulceration, and heals it 
in a day or two more. It is said to cure follicular and phagedenic 
ulceration like a charm. Dr. Lloyd Roberts says, that chlorate of 
potash, taken internally, and used as a lotion, is useful in the teasing 
dryness of the macons membrane of the throat left after diphtheria 
and scarlatina. 

It is largely used in full doses in diphtheria, acnte sore throat, and 
scarlatina. 

Dr. Leonard Sedgwick speaks highly of chlorate of potash in 
catarrh ; he says, it quickly relieves stuffing of the nose, rawness of 
the throat, and thickness of voice. Taken early and frequently, it 
will stop many a cold. Eight or ten lozenges should be sucked in the 
twenty-four hours. 

Some assert that the action of chlorate of potash is simply local, 
and that its good effects are all due to its topical application. 

Chlorate of soda is more soluble than chlorate of potash, and ap- 
peors to be equally serviceable. 

Chlorate of potash seems to produce but little effect on the stomach, 
unless taken in considerable quantities, when, like the nitrates, it 
inflames the mncous membrane, and produces both vomiting and 
diarrhoea. It is not employed in diseases of the stomach. 

Owing to its high diffusion- power it passes readily into the blood. 



220 



AUIJI. 



but owinff to ila alislit Kolnbilily, a lai-gc quantitj- of this eolt cannot 
Bnct its WBjr qnickly into this tluiil. 

A» dua M)t vaaily [MU-tH vriUi oxygon, H wm at one time HuppOMtl, 

'that by fioMing up tJiU olctnent to tlie 1>lood and tiasuos, it migbt 

proniota oxidation ; but curef ul obtHin-ntionK h&Tv concltisivolj proved 

the oiToneoanieM of this xigve, as the sail cin be obtained nnaltvrod 

from t^tirine. 

It luu bovn reoommcndcd in Encikl ncni-al^o. 

Its influence, if 00/, on the oi;g*ua of tli« body is nnlcnown. 



ALUit, DRIED ALCW. ACKTATE OF ALUMINA. 

Tbc^k anits are employed almost exi'lusirely as topical aatruigcat«. 

llioyaotH itatrii^nts in virtue, it issupposod, of tli«irca)indtjr 
to voile with albamen, and coagolate it. 

Tfa<!f produce no effect on €b» entira skin; but when apjilk-d lo 
sorvH, the; conflate the aJbitmen of tbe pas. mucus, or of tJie ttatncit 
lliemselves, thns ooating the sore ivitb an iinjiumieablv Injor, and 
pr<yt«Dtiiig it from tliu action of the air. Like tbo mita of many otluir 
metals, alum may bo ne«d to form this j^rotcctive c>oating. These 
agents have a fnrtlier action than tliat just described ; for. as jnst 
slatodt they act as astriiigenta hy combining vritli and condenKng tbo 
tiiraas. Tbe topical application of alnm contntcts tbu 1 lirrt Tiannli. 
and lessens Uifi snpplyof liloodto a sore. Bj ooastringiag tlie Uood. 
resBcIs, and by condnDsing tbe tassnoe themsolvM, tha members of 
tilts group will depress tiie vital action Of a sore, and so check Uw 
ae(!rerion of macna or pas. For this purpose alam is applied dry, or 
in Nolulion, to rehucod and abundantly secreting sores. 

In such cases ntlicr astringentn generally sacoeod bett«r. 

Alom solutions may l>o applied to free-weepin^ eoEenuitttns sur- 
fncvs to check profnae diecbarge, and to bring the 4<raplion tnU) a 
raodition snited for other ramedica. Like other astriiigonla, alnm 
ia genomlly insuUioicnt to l»enl e<>iiinnii. 

Owing to tiwir pro|M)f1y of condensing tjanies and C(ia(^Uttag 
albunieo, tbcse substancws may bo nwtd to control the milder funns at 
bitnling, aa<t nlnm in an emargenry has tlin adrnntago uf Uiin;t 
almost always at liand. In MPrun hatmorrltage other tnatmvnt in nf 
i»aran mquiiTol. but to check the blmdiiig ol tbe gutna, of |iilaea 
leeclt.bitesoriOiglit <-utN, alnm dustcil on the ii(reQte<l [mrt, flmtwi]^ 
iugit dry, or applied in ajtrelty strong solution, isgenondly sofUciuiL 



iUSH. 



S31 



P 



. 



lo epielaxia alam may be injectod into the nunc, or uaj be iinuffed 
it|> sa the dried jKiwdcr. 

In fltroag solutions (&ix grnimt to tho onnco) nlum bu boon rooam- 
inflnded, thongb it in litilo nsedi in proUpoed anus or Dteni& 

In rulvitiB of children, fow remedies am bo oomparod to nlom, 
used in tho KlriMigth of sixty gnuastoft pint of water, and frequentlf 
upplied, everj hour or oftetiin-, bjr the holp a! a nyringv, lo the secret- 
ing Kurfoce, first wuhing awajr the pus with warm wat«r and tfacm 
applying between the parts a piece i>f lint snaked in tho lotion. 
AltbonghgenemllymicccKshil, this treatment sometimes fails to cheot 
this tronblewtme complaint, even when it cannot be tnM»d to any 
irritation, a« nornm, constipntion or teething. Li some cases Uie dis- 
charge, besides conung from tlie sarhoe of the Tulrg), is poured oat 
from tho lining membmno of tlio vagina, when it is neoessary to take 
onre to paw tho injection np the vagina. Want of attention to this 
faot explains the oocasional failore of treatrnt-nt and apparent 
obstinacy of Ibe CMe. This solntion jntit reconiniendirtt inny soroo- 
times prove too strong, incrcaeing botlt the inflammation and tho 
discharge, uhvu. of vourst', it« ntninglli must bo reduced. 

Similar solutions are asofal in chronic olorrbcea, but alum is far 
inferior to glycurinu of ttinuic acid. 

A solution of aJum, of the etrenglh of ciglit grains to tb« ooaoo 
of water, is an exiTL'Uciil ncilution inxinipli-sutidefipuoinily inpnrotont, 
oj^tholmia of cbildien. The couJDncli\'a must be well washed with 
il every qaartor of au hour, for Kauoesa depends on tlii! frciiaeucy of 
t1>e application. Simple water, as frequently a]*pUed, is a usoful. 
altJiongh inferior, Nubntituto. 

Few sul'Ntances are as nsefol as alom in certain diseases of the 
mouth. Thnii, in simple ulcerative vtomatitiji— that form wbioh. 
beginning at tho edge of tbe gums, and never sprooding far boyend, is 
often limited or moKt marked over one half of the jair — gives way iu 
a few days to dried alum npplied n ith tbo finger many timcn a day. 
It is not merely astringent; bnt, from itii attraotion for water (wbicl< 
it has lost by being heated), it is also slightly cwharotic, and gently 
atimokting to tlio indolent tissnoa. Ulccn like these, prodnco nlcera- 
tion by contact with tho contiguous mncous ntenibrabo of tho tengao 
or check. 

Apbthoas ulcers, showing but little disposition to hctU, or indeed, 
tending to sprtad, may be touched with dried alum a few timcaa day 
with tlio bcttt utfeot. Usually, no such application ia re([ttired, and 
chlorate of potash, and perhaps a |inrg<itivc, are all that ts neooMory- 
Other fvrmn of alccration may be treated in tlio Mme way. Alom i« 
reooronMnded to be applied to tho tlu-oal, either dry or in solnLion, in 
simple or scarlatinal sore-throat, in tonsillitis, and even diphtlLeria. 



232 



ihVU. 



Alum being now littJo used in aaj of llii'wc cau*. il« >dT0Mt«8, 
perhaps, osa^igoraUtd it« good cSecta. 

Ii ia MtMcrtcd that ton gmaa of powdvnxl slnm, placed dry on the 
tonf^ie, will Bometimea arrest a paroiyau of asthma. 

Oftrglea of alum iim fnoTv n«cfal in olirooic inHamtnationa of tli« 
throat, whon tbo macwua membrane U relaxed sod cororod witli a 
gief tnacua or witli pan ; bat althongh nlnm is liigUy aaefnl, the 
^jeorino of taamn is a eureraiid leas dim^roenbl« applickiinn. 

Mmhj caMS of clirunic oiadM apoedilj field to a aolution of alnm, 
a draohin to the pint, applied by an in-igflting tnb«. Abunt a foot 
above the patient 'm head ui a jag containiitf; tbc solution, and in thla 
jng onv Mui of an elastic tabe ia plnccd. Tbo solution in then lackad 
or inanipulatrd into the tube, wbtn the free end is ptnced in one 
noatril, nod tlie ala of the nose preased on it to necum it in lUHitioiL 
i]erewehaveBa5phan,aud the fluid runs from the reaaol tbroogb tW 
tnbo, ODO ap one noatril. ronnd the aeptnm, and down the ot]>cr noNlril, 
waabing the ainnoratiee of the naaal membrane mooi thorongUy. 
The head iji bent a little forwani, and tbo nontli mnct bo kqit open, 
and if properly maiiagcid, nunc o( the aolnticn eacapes bj the ntonth, 
or runs down the throat. Kvon when tliis irrigntioo fails to entdtcate 
tlM diaoasc, it checks the disL-liarFTe, and removes the uScasive small 
dependiu^; ou decumpoMiii; ntntteni. Sonu< prefer acetate of alumina 
as morv eOGoieDt in oorroctioK the fct-tor than Kunple ninnt. If the 
fcBtor peraiiil, the application >ltould bo utwd twice a day. or oftcnor. 
U tMtt fcotor IS very groat, a weak solution of pennanfpuiale of polaali 
or carboliv iu;id may be n«ed. A waitfa of a solation of gljreeriiM of 
tannin in water is often naefnl. 

A alrct^ Molution of alum iit somcttmea oHctnl in pmn'tus riilrv. 

Ten grains of alnm to llio ounce of water is nsed in the form of 
■praj for chronic Doughs and hoaraaocaK. 

Alnm boliavn in tbo stomach, ason Uiodenndodskin ; it coaf^nlatM 
Uie albumen, and ponslringcs the mncooa nM-'inlMiuiu ; and it liindetfl 
digaatioD bf each of theae prooeaaes. ll will often check bleeding 
from the itonacb, bat it is inferior to ollutr aiitriagenla. It somo- 
timea controls vuioiting. In six to ten-t^rnin doses it aotnetimea 
oheeka olNttlnalo forms of xi^niiting, occnning in phtbiKicnl |ialionta^ 
Siqiecinlljr thnt form i.-\L-iUii by coughing. 

Dr. Uoigs speaks ror)' highly of alum emcties for children, and hn 
IMvfem it to other tmietioa in eroop He gives a dracbm in honey 
or syrup every ti-n or lifteen minatea, till the eliild vomits, Imt a 
aocond doao is not generally t«(|Birod. Alum, bo says, dom nut 
weaken, and does not lose ita cffecta ao hoon as antimoay or ipeoa. 
cuanltD, but my experience by no moon* confirms ihis statotnont. Dr. 
Uoiga atmngly adfoeatea tbo employnwat of vrnvtics in Ime croup. 



iLVU. 



2S3 



and Uiinks tbal m*ay Utsb might Ik saved were tbojr more oommoittj 
niifd and repmied oftener. In Mvcrc «i«e«, lie produww vomitinK 
thrae or four tiinort «, dnj or eveu oftener. This troatment laiut be 
bi^n early. 

Alnm checks secrctinn from the mucous mombranc of the mteettneSt 
and eonstipalMt by renderiof* the content* of the ciuial more coDipa4;t 
■Old more difficult of propulnioii. Alum is sometimes used in both 
acute and chronic diarrbaii. and it has provwd useful in the diftrrheea 
of tjpboid fever and of dyjicuterj-. 

It is nucertain how far the members of this gronp paM down tho 
intntinal canal, bnt probably not far, witliout being decomposed and 
randered inert. Alum, extolled by many hig^li antlioritiea in lead 
ofklic, it nid to removft the *pa«m nnd the pain, and at the same timo 
to noload the bowels more speedily and cort«inly than other remedies. 
It ia given tn Gomxiderable qunnlitien, aa roueh as ten gnuns oyctJ' 
hour. The few tiials I havo given thin trcftlnicnt liuvo not been re- 
Wftrded with suooess. 

Tlio long-conttDuod administration of these sabstoncci produces toss 
of appetite, constipation, and at lost chronic catarrh of the Btomach 
and intestines. Lcirgo dotes cause gastro-cntoritis at once, with its 
nsnal symji turns. 

^Vheu t)io acute iitagv of whooping-cough ia over, and when there 
is no frvcr nor inBamnuttion of the lungs, nor any irritation of the 
teeth, atom is uu oxcelleut remedy. In fact, it is nsofnl only in nn- 
oomplicatcd cases ; but in these, few remedies give more satisfactory 
reeoltA It speedily rvdnocs the violence and fnN|uency of the jiarox- 
yums, often, indoe^d, at onco lessoning their recurrenco ono-half.uud 
in fact, it often straightway cures. 

Alnm cheeks llie troublesome vomiting so often met with in whooj)- 
ing>oongli, anil muub iinprovos tho ap[»olit<, — effeota oluiervod some- 
timweren before the congh undergoes any diminution. Constijiation 
mely happens. 

Alum may control whoop in g^:ou g b i^im ply by ita astringent action on 
the throat, and in soppurt of thin conjeotnre, otlivr nutringent sab- 
Btanccs, aa tannin, &c., aro likewise nsefnl (see Tannin), even when 
Applitid to the tbroat only. Alum itself, nets t)Cft wlitm mixed with 
some tenacious fluid, aagum, glycerine, or honey, so tliattho solution 
is TDBtii! to cling Konio time about tlie fauces. 

The alum should bo given in doses varyin|r from two to six gmina 
every threo hoan, or it may be given hourly in ooTresponding doscsL 
Alum is generally beneflcial in the paroxysmal cough, whicli nmy 
continue a long timo after tiio (ji*racleristio whoop ha« disappeared, 
■nd in otlier eongha having the same spasmodic obarooter. 

It in unknown bow much of th(«o substnnces ts absorbed by tho in- 



234 



MiepABJkTioxs or tkox. 



tesUnee, and coiiToj-i>d into the blood, but probably noi a large <iaui-;j 
titj. Tha ehiot pnri cuonpcs by tlio ttevea, wlitch tha almii ia 
to nake Brmer and odotu-lesa. 

Dr. Jnttin findii Umt u ^nun nnd a balf of salpbatc of alnii 
oa« graia of bismutli. iritb enough extract of gvntian lo fonu a |h11. 
to bo taken nigbi and moraing, in rn^eful in cbronio comilipution. 

It in doablfal if alum ha« much eifoot na a remoto nstrin^nt to 
obeek bleQilio^' from thu lauga, ntoroa, kidncya, etc., and to obeck 
profueo sweating atid disclmi'g«a. Alum injections, ono draobm to 
a pint, utnjiloyed in the manner diroctod for tho injection of cat^ 
bonate of soda (see Potash Crronp), are very nsefnl to check lo«- 
oorrhuttl diHcburgoi. Thv alotn aijlution ccinxtringcs tlto parta, i 
eometimea catues aerere oramp-like pains in the belly. 



PREPARATIOKS OF IRON. 

IltOit ia » ooiMtont and uoocMary conHtittuiRt of tho body, and muflk- 
be regarded as an important food. 

None of tbo propamtionii of this matal applied to tlie akin pro- 
dnco any obango in it. Several of the soluble salts combine witb 
albuaeii on imw mirfncc*, sorvii, and innoona nutmbrnne, oondsnung 
tbo tisniefl, and constringinK tJio blood*voaselfl ; and, beridw liiis 
iHtrinfcvnt action, they at tho tamo tim» Mt as Miinnlatit« or irriUnla, 
according to the s(n.-n^h of tils appboalton or the condition of tiw 
sore. 

The organic salts ara lees a«tringent and stimnlatini* than the 
inDrganioi while of the inorKanic, the ferric salta poMcn tliflw 
pn>p«rtin in n gnator degree than the ferroun salts. 

SovenU compounds of iron niay be ctnplojod as astringenta and 
Mtiuralaata ; but, when a Htitnalaot is rvqnircd, other tnotallin pre- 
jwrations are prefentble. The nulpbate, and eapeoially the forrio 
i-btoriilo, eolid or in solntion, are emptoyei) to check biemOTThagv. 
The chloride ia a jwnrcrfal atyivtto, and readily controls the blcvding 
from etnall veeseU, bnt it baa tho diaadmntage of irritating the 
Mtirfaoo of woanda, and preventing anian by first intention. Oar> 
boliu acid will protiotily snperwde percbtotide of iron; for tilts 
acid, pn>i)crly iiin[>loyc(l, does not himlor the immedkto ckMUin) of k 
wound. 

Tbe.solnble prep«nitiona of iron lure a metallic astrlngwit taau. 
and Dot on tlio mucooa DMnnbraoe of the nunilh aa on the abnulcd 
akb. 



rRiPAUAiiONS or inos. 



S35 



I 



I 
I 



Iron fiftJts are nerer eraployeil aa iopioat af^onts in diseaees of the 
mnath; nml, ns tlioy <ifi(>n discotour tho torth and stnin the tonjpw 
lilack, cajwcUilj- wkeu the breath contaiDH aulphoceitod hydrogen 
gas, arising from carious tcoth, ote., tlicjr xtwj bo takon Uirongh 
u qaill, iilostt (xibo, or roed. Thej- are couvcuientl; given in the 
form of pill. 

Tbc effect* of (lieu) wits !□ tJto atomncb, differ uncording to tbeir 
|>rO])ertiee. Some nre oetriiigent, stimutating, and in large doses irri- 
tittiiig to tlu: mncouH mcmbrano, lut tbo pemitratfi, the porcldorido, 
the iodide, and tliu -iiilpliute, while tho remaining ;ireparaUona with 
ruspoct to this membrane ftro almost inert. If the stomnch is irri- 
table, bland prejutrationii «{ imn tnuitt be oboaen. It is ott«n ictAtitd 
that elitoTotic or untomic patients with week stomaehs roust bo trMited 
with bland unirritatiiif- prejuirationn of iron. In Home inatanooK, no 
donbt, tbo Mtringnmt preparations are nnsiiitod, bnt in most cases 
tbey prodnoe far bettiir nwultH than tho bland forms of iron. A pale, 
flabby, broad, and t«etb .indented ton^^o, indicates almoet alwaja the 
need of tar^-e doles of tho axtring«nt prcpuratinnK of iron. Thirtj' 
drop* ol the tincture, or throe or four ^^ns of the sulphate, msjr be 
girm thna limes a tlnj. Weak anaimic girls, mfforing from pain 
and vomiting after food, with ]>orhapB tenderness of the akin &t the 
opigasti-ium, am ofti'o cITi'etivcly treated by largo qiuMititics of tho 
tinctorc of the perehloride. 

The Holuble propamtions of ii-on cnmbino with the albnmen in the 
stonueb. while tho ioHolublo propaiationa are disaolved to a rnriablo 
extent in tho adds of tlio gaetrio jnico. The reduced iron is pretty 
freely soluble in the (^trie jnioe, bat girea off hydrogen gas, or, if 
the preparation in impure and contsins «. sulphide, sttlplmretted 
hydrogen ; either gaa cauaing croatationtt, and the anlphurettvd 
hydmgCD a very diaiigreuablo taste. The pcroxiilo, if strongly 
licat'Od, is soluble in the stomach vrilh gr^at difficulty; the mora 
slightly heated forms should therefore be preferred. The carbonate 
and tlie mngnetio oxide are more easily disaolred than the SMquioxide. 

Solutions of astringent preparation)! ef iron, a* a dnkchm of tli« 
eolotion of the snhsnlphate in eight ounces of water, are reoonuDended 
in bloediag from the noso or lunge, and even insufflation of tho 
powdered aolpliate has been sncoessfiUly employed; though one 
would expect this timtmonl would excite cough, and ^vonr bleeding. 
Thin Epray aUo ia naoftil in chronie ouena. 

Tincture of iron, painted over an erydpclatoos surface, is a useful 
ap]>licatton. This treatment is commended in the erysipelas fol- 
lowing rnccination. 

The oatringcut pre{>amtiona, an the peivhloride, acetate, pemitrate 
or snlphftte, are employed te che<^ hnmorrhage from tho stomach. 



236 



PBEPAKATIOHS or ISOX. 



In proportion to their utringoncy, thetio pivptHntiotis confina tlw 
boirds; bnt to tiut rula tliore arc exceptions. Since after quitting 
tbe stonueh thuy uu Moon ohiinged ioto nn inaolnhle and inert 
sulphide, tfaoir nstring«ncj must extend itsolf on tlie appw put 
of tiie BmsU int<slina*. 

Tbo BnlpliKU). tu.'ctAtc porchloride, pomitrato, in oommon with 
other astringent melAllic preiHurationa, may t>e giren in diarrhitu. 
The pemitmte, mtwh prai«ed in tlio chronic forms of tliarrboDa, is 
probably an etHoient {>reparatioa. 

In bleeding from the Ktomocli smnll doueof the Afilringent propam- 
tionsin irod watersbottldbegireit hoarlj. 

Owing: t" 'lio astringmcjr of iron salte, each dose should bo oonu 
bineil wiih Mint' laxative, oa a quarter of a grain of aloes, a few grains 
to.bnif a drachiii of sulphate of magnesiBi soda, or potii«li. Some 
autborilicM consider that the combination of iron with a laxative 
markedly promotos the absorption of the iron. 

In their course alone the intestines, iron salts, as n-e havti said, ara 
changed into a sulphide of the metal, ^ving to llio fteoos a bbok and 
ohaiaeteristic appearance. A very mnall qnantitj of an iron salt is 
Rnffioieot to stain tho motions deeply, and to keep them darkened for 
. HTCral days after its disoontinnaDoe. Iron salts liarc no direct in- 
flDOice on tho pauoroatjc or biliaiy socrotions. 

Id the treatment uf tbc oniall thread-worms infecting the reotiUB, 
the tincture or tho scvquichloridc, in tbo stivn^h ol n drachm of tlio 
tincture to half a pint of water, is an elBcient injection ; it coagulates 
the albumitn. and destroys llie thread-worms. 

Il is au interesting and iinpnrtant qoeslion — How macli iroo ts 
absorbed into tho blood ? FrotMd)1y hut little of the inMloblo forms, 
as Ibe i|nantity of aoid in tlie stomach is not adequate to disaolv 
llicm ; and as regards tbo soluble preparations, it i« hard to say hoi 
niQcb gets into tho blood. Tbo increaso of the iron in tho urine lNitig~ 
vi-T)' slight, after administering a soluble iron salt, it has boon COD* 
eluded that very little passes into the blood ; and ibu fact tliat altnost 
all the iron taken by the month may bo ra-obtaincd from the fa 
seems to ktrvngthon this view : but an oxtendnd knowledge oonc 
ing the eliminalion of metsln from Lho body hIidwh tlii* oonelusfaio i 
be fallacious- t'rolMbly most metals, but ocrtainly iron, an) 
nated from th« system through lliu intostinas, aiitl make thoir sail 
with the fnoos : fur, when iron salts am injected into the blood, 
almost all the metal is ultimately reoovemhlo from the fsKSS. That 
much more is absorbed than is apiTopriatud by tho blood curpusclus, 
is shown by the colonlion iron produces in all the nlbumtiKiaa iwcrn* 
tioiis of the liody, the fluids bathing tho vnriiras oaviues beoonuag 
Miouiud roddiah-brown. 



PMEPARATIOXS OP IKOX. 



237 



P 



Oxtdoof iron jioimihuom an oisoaiBinBrpowcr. "Thua, ft spot oE iron 
mould, i.e., iron oxide, on linen, will, in lime, (leatroy tlie fabric. 
From n tumiliu- canso n fleck of rust on n bright Hnrfnoo of stcol will 
8t«adi]y onlargo tutd deepen." (Horatio Wood.) Uenco it til ai^ned 
that till! iron of th« blood corpoaclcit actc in tfao muao way, oonToiting 
oxygen into ozono, thua promoting oxidation ; oxava being tb« aetiw 
form of oxy^D in the ayatcm. 

In tli« treotmont of nnifinia, many physicians advooata the nxo of 
lai^ dcsei of iron salU ; othom, instancing tJto bensficiK) affects of 
fomiginnaK wntcrK, Ktrnniioniily maintttin lltat al! tho good effecbt are 
obtainahlo from very ainall dowin. In many inetancoe, no doubt, 
anmaaa, is cnniblo by Iho employment of small quantities of 
iron, but it is Ukewide oortun tlut lurKi) i|iiantitiL-ii, wln^ thoy 
cau bo home, act for mora promptly. Ualf-dracbm doaes of the 
tinoturo, OT nix to eight graiu.-! of tim anlpbato, m«y bo given two or 
three times daily. The following pill, originally omployod by Blaud, 
and xtrongly TOcommended by Niemtsyor, iM, no doubt, very ef&caciona 
bat tbo iron witliout tho cftrbonate appears to nnsvrcr as troll ; — 
itulplinto of iron, carlranate of potash, of each half an ounoo; irago- 
canth, tm mucli as is roijnirod to molco ninoty-eix pills ; thrco to bo 
token threo tiinee a day. an additional pill heiug adduil daily 

Aconveniont pill is nuulu with fivo grainit of tbo dried sulphate of 
iron, equal to alionl nino grtins of tho ordinary sulphate, with a drop 
of syrup. Tliix xtlii into n firm jilll, ituily disiolved in the stomach ; 
a Huall quantity of exti^t of bcUadonua maybe added to prevant 
constipation, but when given aloni.\ this pill seldom constipates. 
Ijitrg^i iIosM of iron, while larely npsetting the stomach, or |>n>dna- 
ing headaich<>. often cnro "^"'i* with aatoniahtng mpidity. This 
pill is Mpociatly uKufnl in chlorovia. 

The experiments of Drs. Cutler and Bradford, conducted aflcr 
WnlniWfmr'it method of counting tbo blood oorpusolos, show that iron 
doe* not inorenae tho number of blood corpuscles in health, though 
it does in nnntniia. 

In nnrcinia wo have both de6oienoy in tJie amount of rod corpuscles 
and deficiency in the quantity of colouring matter in tho corpusclea ; 
or dcfectiTO colomtion may exist alone. Iron incrouiOH both tho 
colouring matter in the corpnaolcs and the quantity of corpuscles. 

In antemia, iron salts posses other importaut propurtioi than thoir 
influence orcr Ibo growth of tho corpuscles. They act bracingly on 
the relaxed mnoona mcmbrauu of the dIgestiTe cooal, and probtbly 
in this way tnud to restore its functions. Uontorcr, it is highly 
probable that niter it« (uitrance into the blood, the iron exerts an 
inflnencG beyond that of merely increasing the quantity of rod cor- 
puscles; houcu iron s&ltsaiv useful, not ouly as a food to promote the 



238 



or IBOJT. 



fornutiion ot blood discs, bat likewieo on aceonni o( thtdr beneftoi&l 
influenoo on tha tistnes. Iioo, tberofors, nimU bo rognnled as « 
food, and also u an important carattvo aip<iit. Wh«re it is donrad 
to bonofit tooicall)- the macoiiH laembntne of tbc digestive canal and 
the tisanes, lar^ quantiticH of tlia aolnfalo astringent pteparatioiis 
should bo admiiuEtorocI. 

The experlcBoa of pbyiticiunH of tho liMt gi-narnlion accorded irltb 
tbaoo vifiirs, and so <loes tbnt of miuif hii;lilf pntotical men of tlw 
preeeat daf ; bnt, on tlio introductioii of tUo bland and alm<wi tAiit«- 
1«w prepaimtiona of iron, thtiy irirre assumed to bo in evvry way 
superior to the astnnf^eat fonnn. Tlioir rompnnitirc tastaleeaocM in 
oertHinlf in tUeir fav<nir. It used to bo ronsiderctl, tnainljr on sp«cu- 
latii.'e RTOtiDdR, tliM the aatnuvreni pn>fiiiniti<inM must disorder diges- 
tion ; and tboso thcorotacol, nnd hs I biTlii^vii nnfoundod, opinions atill 
prorail. In n cortaiti olass of annmio patients, tbo astriuffeat pre- 
parations, even in Urge do»c«, are preferable, and a Ini^ tiban of 
tbuir efficacy is dne to their direct action on the mooons tnembnno 
of tbo stomach and intestines, and on the organs which stodtbem. It 
ha* bnon expL-rimont&tlj- shown thnt snijilutu of iron does not cheek 
tha aolvont action of tbu frastric jnice, and eiporicnco jnntifies ihocon- 
olunon that in weak luucmio patiotits it does not lessen, bnt rather 
inerettMs the fennation of this Kocrnlion. 

If the digestive miicons metnfaraiM is in an irritable state, then, d^ 
has been prarioasly pninted out, the astringent iron propnrationa, in 
full doHM, may do liann. 

fudividnal poeuHaritice mnst bo taken intoaoconnt. Some petvoos 
cannot take iron in any form, not even ft single dowof a weak ferroKi- 
imhu water. Iron npaets tho digestive orga»s of somr juitienta, nr i( in- 
dac«8 futnosK aitd pain in the head ; otJwre again take it not imly 
without inoo&venienoe, Imt with great beooliL 

It is MHBolinieH ndvisablc to humour tho stomach by chaajpni; oo- 
caskxnally the preparation of iron. 

AooerdinK tomoHtanllioriticH, Iheirouin the blood oomUnes with 
albtinen. Uomard thinks it exist* in tlie blood as a pmtoilde. 
TTodsr oerlain ooaditions. Iron increoaoa the quantity of blncid oor- 
pneetes, ami in tlita way iRi]trovM the general nutrition of the body. 

Thuii. iron salts nre useful " in naladica attowlcd with dofoct of 
the red oortiuscles ; as in amentia, with or witboul irregularity tif 
tho Dtorine functions (obloruais, antcncrrlMeu, dysmamorHiam, and 
menarrhaifia), wliolhar oooarring spontanronsly and withoat any 
obvious caase, or temliiag from pmfnse disohargos (huBHUThagiM, 
Hnxee, or leuoorrboia, A&}, or from food detootive ia either i|iiui- 
tity nr (ptalitv, and from de(i«ioncy uf li^ht sud pure air. If oun- 
Joiiwd with GuUk'icnt oonrisbing food, pure air, nfauudnnce of light* 



I 
I 



1-BErAlUT!03fS (ff IKCW. 



939 



nnd. vrben Decessary, thoemplofmoDtof pnrgntivei', iron cuteithan 
BDfpRiic cnscH. Bnl, wb«i the atuBtnia or lijdmnnia t§ depondont on 
oi^nio dutease, as coacor, ^rtnuliu- dcgunentioii ot the Icidnof, or 
morbia cordis, iron at boit ia on]; palliative." 

" In aomo obronii; affeutious of the nervoas trrstem, iron is of prcitt 
benclit. Choraa, in a lafgo number of cssce, lohy bo n^Hnvod. and 
oft«nlimeii cured, by cbaljbeatoH. thoagh in general areeuic tisnallj 
cures chorea macb moro spoodily and certainly. Casoa, Iiowdvcf, 
■omietiiiuiB occur in which the cbalybeates are preferable, as irbero 
anspmia co-oxiste. Kpilepsy s.nd byst«ri& tre smnotinm bcnofilcd l>y 
n eouraeof iron, eejwoially vrbou thoy are attended with aiuemia or 
aterine obBtmctions." (I'croim.) 

Tho 1ong<con tinned nco of iron in highly beneficial in ttorofnia 
and rickets. 

Iron-aallii ara commonly adminiNt«red in amcnorrhoNi; aa tJiere ia 
usually mnch anaemia conjoinod vriih this affoction, tbo imn, in to- 
m«dying the anojmia, assiHla in reNtoring the ntcrino ftmctionM. 

It muet bo remcmborod that anannia i§ dependent, not on doticioncy 
in the supply of iron, but on ita ticanly iu»imilntion ; hemic iron muMt 
be coujoinod vrith woU .regulated hygienic conditiona, otlierwiBo it 
does comparatively little good. 

In a case of neuralgia with ana>mia when no organic canae can be 
discoTcrcd, ruIu of inm are enpecially reoorameitd«l, although it iit 
tane their action ia uncertain. The Iinge doves of tlieae salta some* ■ 
times given, especially of the smquioxido, are probably injurious, and 
exert less inlloence over the disease than smaller ones. 

IiMfge doses of pnrchbridc of iron arc of gnat benefit in dipbtbena. 
Better use the aolntion ratlicr than the tiitcturo, and to gire the 
medicino rcry froqnmtly — every hour, or oven oftencr. It is uncer- 
tain whether the ^oota on the throat depends on thu topical action 
of the medicine, or after its entrance into the blood. The solntion 
abonld he Erei|aoutly painted on the throat, talcing grrntputiit to apply 
itvwy gently, lc*t by incroamng the inflamnialioii it may do more 
harm than good ; thia prooc« appears to arrest the spread of tho 
diseose. and it is said io maintain the patients Mn'ngth. Tlic Kiilntion 
may bo npptied with thu ntatnitrr. ho ns to penetrate into the tmcben 
and bronchial tubes. Large hourly doses of pcrcbloride have IiMin 
found of great use in erysipelas, though with some obitcrTDra this 
treatment lias altogether failed, a rennlt perhaps due to tho lon^ in- 
tervals between the dnwts. Tlio /rtftttfit repetition of the medicine is 
one of the moat necessary conditioux of snocoss. 

In tho soHjalled hysteria of middle-aged women, oocurring eepe- 
ctally at tho ccaflktion of menttraatioti, they often erperience dis- 
tressing Mattering of the heart, a sensation of fulness of the Iiead. 



2-10 



p&£FiKAT:oNa or aos. 



with heat, ami wei|;lit on tho vertex, freqncut flnshings of the fitos. 
Mill " lint and cold perapiniioas." Tbia combiualiun of t^niptOBU 
is gtoLerBllj romovod by conside ruble doiwN of tliv Msqaichlorido of 
iron, ^ven Uirec limes a (lay. If tbo nyinptoniB are ttmiU'd to tho 
bend sad ftioo, other rotncdiw ara taotv nuaetMtal, as nax vomiva, 
opinia, belladonna, bromiilo of potiusinm, nitrite of lunjl. 

SnItH of iron aonictinioit oxcito irritation of th« btiiddor, wilJi [re- 
qucul dcaire to pncK watvr, wliic'h may contain a oonaiderahlfl quan- 
tity of mncns. "With children llioy may oauao Dootttmal incontinanoe 
of uHdo, y«t iron itallA not u&friKiut-ntly caret this trooblesoEtie com> 
plaint, ovon wbeu not dcpondont on wornia in the recttiRi, or other 
irritatJ0&> Astringent prupiumtions of Iron am otnployod to anvafc 
hmoorrhagca from the Inngs and kidn«y8; the acetate is tbo boat 
preparation, nod tho folloiring in atated to be a very offoctual way ia 
odminiHter it : — Add snfficiont salt of iron to water to nuke it tasto 
distinctly Init not iliiiafptwably, and lot tho patient constantly Bi[i 
this aolntioa. A safficient quantity can thus be taken vrkhoat 
eioilbg itansca or dittgust ; indeed, it is often liked. 

Salt* of iruu np|>enr to Ii'sacn prafnso eecretiona, moh an ooow 
in eltronic bronohitls and leuuorrhoM. Dr. Grarc* gnrv tho oom- 
pound iron mixturc<, in <lase8 of one or two fluid draohma, to check 
oxoowive broDcliial secretion. 

The iodide of iron may bo giren where both iron aod iodide are 
indwat«d| for inataaoe in syphilis oomplicalod with annmia. It is 
a question of mach interest vrhclber it is better to adminietcr tjieae 
two agunte Kepamtely or combined in the iodide of iron, and whutbcr 
the constituents continoe tn combination in their coareo ibrongh the 
atomaab and ciroolation, or wbethor the salt is deoumponed. Viewing 
tbia question simply from a oboiuical point of viow, it nonld aoem 
tliat an iodide of sodium and (dbiuuinate of !n>u uittat tie funned in 
the stomacli or blood, tliongh some obM-rrations, made I beliere 
by Bernard, tbran much doubt on this conclnsioa i for It was found 
that if iodido of potassinm and a salt c( iron wcro injected into tlie 
blood, DO iron appeared in tlie ealin, but wbcu an iodide of iron was 
injectt*!, then both iodide and iron woru fonml in Lliin atiorettoa. 

1'bo iron of the effete red corpn&cles probably escapes with ih» 
bile 1 and when iron salts am itiridlowcd, tbia flaiil contains an cxooM 
of llie metal. Tliis, therefore, is one way by whtcli iron may be 
•upamted from tho body, 

Its fortbor seiwration takes place by moans uf the all>uminoua 
MDcrvtion of membranes; and to iron, like most otluir mel&ls, rin^r 
probably exists in the body only as ait albuminate, it has been oon- 
juctunid that it can bo nejiamted only by the secrt-iioiu containing 
albuaen) und certain facts and conaidecatioDs favour this riew. 



ULTS OF MiXOlXBSR. 



sa 



h 



Whon iron iit Injected into tlic blood, mnch of it rmppean in a Hhort 
tim« on tlio snrfacea yioldiu;; an albuminotta secretion, as the uucoaB 
mcmbmjie of tho iotiiHtiniM, of ilio broncliinl tulics, of the ^11- 
bladder, of the nrinaiy bladder, and on the Bon>u§ mombmui^s, as 
tbo pericEu'diani, poritononm, and ploniu. A Nnmll quantity otca[)M 
with tliB arino; but w bet lier excreted by the kidneys, or aeparatAd 
by the mDcoaM meiabntDo lining tho nrinory ponngo, id nnccrtaio. 
Some maintain tliat it ih depanUeil by thv tnucou^ monibraDe. and in 
Knpport of tlik riosi it is nrgcd that, wboii Uio iron of tbo urine 
ia mncfa iuomMid, irritation of the mueoua meuibmne always sets id, 
ns is ihown by the frocincnt dcsiro to mako nnler, and l>y tbo vxocwt 
of moong in the nHiif. 

To Dr. Bumf-s iro nro indebted for Imving imggRttctl ihv injoction 
of porchloride of iruu into the uttirus in ){raro eases of tlooding nflcr 
<lolivory. In such caws, obEtelriciAHS aro well-nigh agreed that lhi« 
procedore ia eflectiro »nd life-Mtving. Dr. Barnes iccommondK four 
oancesof tho liqnor fcrri |)orchloridi mixed with twrelvo of wakr. t« 
be slowly injected into tlio nt«rnK with a I! igifi neon's syringe, fur- 
nished with n long ntcriiu) tube, Uktng c»re to avoid the introduelion 
of ftir and to allow a frvu outlet of tho fluid. 

In rfironic ntorino catarrh with clear whit<--of-i'gg.Ioi>king diM- 
charge issuing fmin a [MitutouH iiUtuii, [)r. Lloyd Hoberts recom- 
mends sn-abbing the interior of the organ with a solution oonipotwd 
of ono part of perobtorido of iron to fonr of water ; or tlio injection 
of a few drops of the nalution. 

The tincttirt! of tbr pcrchloridc of iron, in tbc proportion of half 
A draohm to half a pint of wat«r, witli u draehtii of Undanam, makes 
ft cnpitid injection for gonorrhoM orglcot, ofton speedily checking 
tho didoli&r([e, and easing the pain on miclnrition. The following 
injection is nsofnl : — Salpbato of iri>n twclvo grains, tinctinxi of 
opium half au oiinou ; nnter eight otuicos, usu tliri'o timi-s a day. 

Tho syrap of iho phnsplintoof iron ieagncHl form, if there are 
any indications for thv cmployinont of pbosphorio a^iid. (See Phos- 
phate of Limo.) 

A tnuipoonful of l«uton juice curcr* the twte of iron pteparatJona 
and tiuctnre of steel. 



SALTS OF MANGANESK. 

Tkk BiiliJiatv of maneaneso in large doses, acting on the mneona mm- 
brone of tbo stomach, Mcit«s vomiting and purging. It ia nid to 
increase the flow of bile, but Rutherford lAys it is » poworfol irritant 
to tho mocous membrane, bat not a chologogue. Uanganese is gnne* 

u 



242 



SALT3 OF UtlCOASESE. 



relly. aod according to mnno inTcatig^ton alwars, fnnnd in the blood 
oorpugdoR, luid Uiu oome to be regarded aa n Dornml cxmstitaent of 
the red disca, which hss led to tlio nclminiKtmtion of ibt mlt« in 
annmiit, thongh, in llie hands of trustworlbj' olMcrrors, withoni any 
IxinefiL 

LMtnd gave ton to firb>ca grain doses of tha btook oxid« in Rwt- 
tMdynia and pTnxidt. Mnngnncse lalla long i>OT8iKtod in pnKloc«, 
utccording to BanJioloir, wasting, feebleness, stagfti-rinfT anil paraplegia. 
They are said to eanat) annto fiitty deg^'neration of the li\'or. 

Thi< pormangnnato ia a powerful oxidimr, yielding oione, and is 
Midftv uKt'd na a disinfectant and doodorixer. 

Barlliulow reaommenda thin preparation in djapcpsia with flatnloooo, 
and to aNiifit tlio ronvarsion of nric add into nn<a. It has been jfivcn 
internally in acarlet ferer, diphtberia, erj-aipeUs, piioqicra) foror, and 
pysDtin ; but the pormanganato can act only on the mucous raem- 
branoi with whioli it oonies in contact, and muat )>e doeomposod in 
the stomach. 

My object in introducing saltA of manganese into tbix e4titii>n. is 
to draw nttcntinn to tlioir efficacy in aomo forma of ampnorrlic»n. For 
tome time past I have Ktndied the action of )icrnu»i annate of potosli 
in cMea of dcttoifnt, dclnyod, or arroxteil menatrnntion, and mv cx- 
porienoe warrauia mo in boapeakitig attention to tbi.i HnbjooL 

Othvr Milla of nmngantiKc wonid, in all pmhnbiUty, act oqaalljr w«)l, 
but I bare not yet hod time to test their action. The poruiaiigaaato 
it«el( cannot pau into Ibv blood andocooipoMd. 

Tlu! pcrmani^niite is uftoful in amenorriuoa of yoang wotum. It 
will nwlorv mcnslmation Kftcr tho lapeo of two yoara orI«l|{«r: 
M>metimea it rratoros the discliarge in a few days, or the rrinro may 
Iw delayed till the n«xt period is doc, or aooiatimes eix woeka or two 
mmtha will elap«n Ixtfora the drag saooeedi. 

I find this salt nt)e^ll al«a in tliu vrry ronimon eaeo of scanty, par. 
Iiapa delayed, memlrual llnx, tlio interval varying from nix wooka to 
two montlis. Hw pomtangunato in a <»to like Ihia hringa on tba 
period at its propor time, with increase in tho (jnantlty. 

It is nseful too, vrli«n a obill prvvenla or delays tlio monatnal flow. 

A woman pruvmtvd monstrnatioo by taking acoldbatb on ihr day ii 
■hunld bareappeaTe<l. and uliv aiiRcnid from the nsoal aymptoma aruiinff 
bom aireet of the vatiuaonia. Three dosca of pommnganate roatorfd 
tlu) llnx. On its appvoranue ake discootinuod tho dntg. when tlio dla. 
charge ccamd. SberotanMH] to the nedioine, andaftvranotberilinM 
doaea the dow ruappcAn>d and progreaaad nalnrulty. 

I Had il eucxwnafu! in oasM of aiinnito, and in |))elhatic {latlaata. 
It certainly iloca not act inj improving ihii tpuiUty of tliu blood. 

It may act at onco^ or not till tlu next petiod la duot or tbu ano. 



I 

I 

I 
I 



243 
ij be nuMcd, ftnd the medidna jMy not pravftil till 

I netiklly give tha salt dlu'ly lill Dk catArnvnin. npjwar, nnd timn 
lUsooittinoe ; but I reoonunenoo it four days bofarv the next period is 
duo Knd rontiiino it till tlio lloir oenNCii. 

At fitst 1 fpiri: the solution of pemimgannte from 5K"- *o 3J. thrioa 
d*>ty, l>ut tin: dinigTDuitblK ln»to ofton prorokod nansca nnd Tnmiliiifr, 
espociallj after taking it for some time. I now pive one grain in pill 
form thriL^c ilnily. Mr. Mitrtinitale nitdccs tlio pills Recording tn tlio 
foUowiiij? formula : — Permaagaiiata of potftah gr. 1, kaoliii Utd pL-tro- 
Ivnin oomto of equal })urtA q. s. 




NITRATE OF BISMCTH, CARBONATE OP BISMUTH. 

Tiiir9iK piivrdcra are commonly used as hannlesa tosmetica ; they are 
nseful ill intertrigo, !ni<l somclimps in wwinn, asdniding powder; but 
in ocxoma othi?r n-niediuM are to be preferred. 

Api^ied to the broken or nnhrokcn Mkin, tlirsn snbiitAncc*, being 
inKiInblo in any fluid they may theu meet with, are not alwnrbed. 

TrouBsean employed oqual parts of binnuth and Vonetinn cnlc in 
ohronio non-Kypbilitic (oamn, ordorinf; tlie patient, after clearing 
the nasal paasages by strongly blowing tbi: nose, to snnJf op some 
of this powder. He, however, prefers mercurial powden. (Seu 
HerDiiry.) 

Being insolnI(li>, llior are la«teleM, but tbey BOmetimca occaiiiou a 
diangroenbte nensation of ronghsess, and sometiniM blaclcon the 
tongne. TliiH rough ttu(t« niny bo co\'ercd in a great dogma by ad- 
ministering the drag in milk. 

Littin in known nt prcocnt of the obanges these medicines undergo, 
and of their bobarionr in the stomnoh. WheUior thoy are diMoJvod 
or not, or whether their elBeoiey depends on pbysieal or cluimicnl pro* 
perttes. ai» qnoetions y«t tmsolrcd. 

In many diseoaea of the Ktonuwh, Iheae prepamtion*, especially tlio 
nitrate, aroTOTy valoablo, onsing tbo pain incident' to many nfFectiona 
of this organ, whttthi-r dcjicuding on orgauio or so-calli'i] functional 
diBBBSe. In cancer, chronic ulccm, nnd chronic iuflammntion of the 
atomach, litnuath in ofton w-rviceable, and in esfiuclHlly uitcfnl in tlio 
ohionio gastritis of drunkards, subduing the pain, checking the 
Tomitlng, and enabling tho stomach to tolerate food. It is nln ubc- 
(ul in gastrotlyniit and cramp of the Htomncfa. Many forms of romit* 

It i 



BISMUTH. 



in^ in cliildren, and noteblj that kind depondiDff on aciil« or chi 
cuUrrli of the atomnoli, jrieiil apeediljr to bucmutli. Tlio rariooa fui 
of pjTOBis, whtttJicr Koid, alloJine. or nontml, nro very nmotuMa to 
this dra^, althoQffh our limited knowledfcc conct- raini^ tlie caoMs of 
tltw tOTOi of indignttion fniU to tmiiltlo ns to Inr down procise raW 
rsBpeding tfae particular form of it tuuat l)enulltt''d br bismatlt. 

Dr. OraTcs trvutiMl m'idity of thv Ktoimicli wjtli nitnito uf bUmatl). 
ftnd expenence confines his pmctice. U« ^netally laixml it witli 
Oj>iiun or morpliia, uid Bomotitnox with nMgncsin. Flatalnnt dy iip(>|>- 
Bia, in BOniie of ita forms, jwlds more or leas to btsmath ; and il is 
witll onmittinim U> mix it with nn uqtuil qaMilitj^ of vcigvtablo 
charcoal. 

Thow ramodtoa oft«n cnvcoiK] in Fomo forms of clironio diiuTbix«, 
fiBpeoially when other druf^ fail, in the oxh&ustini» pur|?ing of pbthi- 
sia. It is ncccsMkr^ to givv he much im hnlf n dmcbm to a dmclim 
of the uitnvte aerersl times a d»y,and tliis lar^ quautit^, taken with 
nuJk, doos not distorb tho •toouoh. It often iinbclatis introotable 
dtwrlioiii, eSocting occasionADj^ m) grcnt an imprav«ment in tho 
gcnoml heidth, that patjenu wlioso speed; dwth seemed ineritaiUe 
rkllf tuid n>cover. 

In tho rnrioiiK forms of diftrrluixt pocnli»r to yonng ohildnm, 
bismnUi, in lar^ doses, is freelj nsed on the continent. A dose of 
thir^ to sixtjr gmins limirl; is rcoommcndod, milk bring at tho wune 
time withhold. Maoh smaller doaee, however, sini often nsofnl, nail 
m»7 be given witli milk : n grain hourljr in vcrj- (TllicaoionK, nnd 
tlm addition of a sixth of a gnin of gnj powder often enhaBovM 
ite ^cac;-. 

BiitmnUi prepnntioaa are not employed to not on the rvmots orgass 
of the body. 

A bismntJi injection, cousiMlng of bismtith half an ounoa, gljriMr- 
ine half an ounce, water three oancos, is vorj naefnl in goni>rrli<Ba. 
Mqwciolly in its chronic stuto, and aometiraes proves MrrioeaUe in 
gleet. 

The chief port, if not all tho binuuth Hwallowed, id oriMituteit with 
the Itaxn, Biul sttiinH the motions n dark slate oolonr, A portion, 
indcvd, may be aheorbed, but the qnantitj entering Lho b]ood i* 
piobalily vxttemclj' Hnall, 



I 



I 
I 



UA]> SALTS, 



245 






W 



LEAD SALTS. 

LxAD mdded to ivIbQminous flnida. forms a pi-ocipitato composed of 
albuminate of ImmI. Like othiT mot«lH, lliu Holiilitc KtilU of tKis group, 
when applied to tho abraded ektn, or to soi-os, or to mucous mom. 
branes, coat tlicm with uu impurmeiiblo nir-proot ooverinf;; if, bow* 
ever, a protecting covering is required, other metals are generally 
employed. Any excewi of lead solution, ufter combinution witli this 
nlbnminoiu part of tho secretion, will Dnilo nith the tissuw tbem- 
eelves, id whicb manner, probably, lead Raltn romU-nie llic«C atroetunw, 
and constringo tho blood •towoIb. The solablo lead salts are nsod as 
lotions to unhcAlthy and OTer^secreling iiorcii, and to eczeinatonit 
4'mptions: load lotions in Kome forms of ecKcma being very useful. 
When thure is mnob inflammation, and when the aurface in raw and 
Kvcfs copiously, a lend lotion allays inflammation, cbocks the dis- 
cliarge, nnd quells the itching, burning, and tingling, so often accom- 
panying ocxoma. Two or threo diachms of liquor plnmbi in ten 
ounces of water are geneinlly Huflioicnt ; but ft stronger lotion, con- 
iHBting of two ounces of liquor plnmbi, two ounces of glyoeriue, and 
four oonces of water, is sometimus morv Kucccesful. Wlien the in- 
flammation is groat, and the weeping abundant, tlio rash most be 
constantly covcnid with mgn Hoakcd in the lotion. In nomo cases it 
is nscfal to apply a poultice at night, and the loliou during tho day. 
The stronger lotion is cspcoially nwfnl in diffused ccaoma, witliont 
weeping, bnt witb excessive itching and tingling, and the diauasod 
Mkin should l)0 upongi-d with the lotion snvcml times a day. A weak 
alkaline, or a sulphur bath, greatly aesiats the notion of the lotion. 
The fluid oozing so nlmndiuitly in oexemn being strongly alkaline, tho 
propel^ of these lotions to check this discharge mfty be owing to 
their weak alkaline reaction {vide the Chapter on tbo Topical In- 
Bueiioo of Adds and Alkalies on the Secrctiouti). The stronger 
lotion Tory effectually allays tho itching of pityriasis. Lead lotions 
occasionally ease the itching of ortiearia. 

A lead lotion is often of great service in prnritns podcndi, especially 
when the mneons membrnne is red and excoriated. A weak lotion 
sometimes fails where a strong one saecceda It may bo necc«eary to 
niH- <^»id jtartfl of liquor plunibi and glycerine, an application which 
may uxcile a little very temporary smarting. When pruritus pndendi 
depends on ascnridea, lta<roorrhoids, or » tnniour in tho urcthnl 
pAsaage, it is obvious that these applications arc useless. 



246 



t-KAD BAtrS. 



A lotion of one part of lujtior plumb!,* wilL one or two parts of 
glyocrino, appHed vr«nn after the cnii>t« Imrv bwn vntirrly removed, 
u anfal ia tii« milder formii of lupus. 

"Wltilelead lalts have many propurtica in rommon n-ilh ItioM 
nthcr rnctabi, tliojr are diatingaisliod by their unirrilntitif*. MMtbii 
t'Uaractcrr, wrhence they are UNvd only am nistringvnt and calming 
npplicadoniL Tbu solablu lend prepamtiouM maj be used to check 
UMdiog from small voeacla ; but other astriutionts ara more ciTccttv*.] 

SolDlionii of tbe ac«tate and diacetate um emptojfd an iujectioni 
and washes in chronic otorrhosa and vulvitis of children. Tlu 
lesoeD the prodtictiou of pna, and cam pain, by virtue of their 
tringoncy and their soothing qualities. They are of most oso whon 
the acute stage has jmt tnbsided, thu tlMBOoa romninini; irritable and 
painful. In the later stages stronger astringeutii an< needed. 

Bland, unirritntinf^ plasters made of load are in common nw\ 

Theso plasters, an<I lead applications generally, are mmetimea 
ofajoetioaable, owing to tho btauk diaeoloration thuy [iroduce front 
the furninlion of the black snlpfaide, with the sulphuretted hydrogen 
gM evolTc<l by the <]ecompoaition of Uio dioohargM. 

A stout plaster often rdioves pain in tlie loins, dno to woakiMBS. 
Bnrgnndy pitch <in leather is (tenernlly uurd, bnt it in very liable 
to produce a crop of itching papiiW, which may spread over tlw 
groater part of the body, while lead plaator, though somowliat la 
ndbesiTc, ia comparatively &ee tiota this objeation. Plasters some 
tiinea relieve back pain« duo to uterine disease, or piles- 

Pot swuikting foet, Ui>l>ra emgiloyH an ointment composed of equal 
parts of lead plaster and linsocd oil spread on linen, and wmpiN>d 
round the feot, rrncwing tho application every third day (araiiio days* 

The same ointmi-nt applied on soft linen twice daily is wmatimoa 
iitvalnuhto in tho snlxtcnte stage of oczvnia. 

In ulceration and klongliiuK of tlto cornea. lead washes most bo 
avoided, Uist a vtiito compound bocoDic deposited in tlvc stniL^turtn 
of tlio aleur, leaving a pennaneob opacity. 

Mr. Alfred Aspland ivoommoDda the local oppltcation of wbito, 
paint for bums. He claims that it ratievea pain in two minutes. 

Load iqJMtioDB are somatinua entployed ia gonorrbtm. ghwt, i 
lovoorrhcea. 

Lead may be absorbed by the sldn in quantity auflk'teni ti> prtMlsoVij 
lead poisoning, enloring the blood probably as an nllmminatc, which 
is aolnble in weak acids and alknlica. Lead poisoning uocnn only 
when the Mtlutionn ure iipplird fonlinuoasly to Ini-pv raw HnrfnoOH|j 
moreovar, thin remote |i>miiibilit; nliunld not in nny way inhibit 
use of load lotions. 

* Wknt Uipmt plnalt ii SMaiional *« nfor lo ite umsg ulsllia. 



LEAD BALT3. 



24r 



Inaolnblo leoi] salts &ro tastolcas; tbo flolable bav« a iirootisli acid 
anil luttringent liiale. 

I'bo solnblo preparations are aetriof^t to tlie muootm m«(mb(«iiie 
of tlie mouth, and combino vrith tho allraminous snbetanew Uwf 
meet with there. 

Thnt portion of the nolnblo oomponnds of land nhicli «Bcapm 
oombuiadon nith albumen in tho mouth is oonrortcd into ma albu- 
minatfi in the stomacb. 

rhn so1abl« lead preparationa are aometimeK niaud in lia>niat4iiDMi«i 
and have beon recommended to chock porosis. 

Albuminate of liiad in the intestinuH ix prolmbly spocdilj decom. 
poMid into a eulphido of lend, an inmilnblo and inert compound. The 
i»liible salts act powerfulljr as astringents of thi> int<<!ttini'x, and oaiuo 
consttpatioD ; they control mnay fonns of diarrha>a, oven that de|)en- 
dent on diiieato of the lower port of the small or even of the loifpe 
intestine. 

The efleots of lead on the parts of the intestines distant from the 
»t(>mach and dnodennm, can bo loiuiifvsted only tlirough the nervoaa 
s^rstom ; and we know tlio inlimute symjtatby exinting bctwocn the 
different pnrla of this canal. 

Id suniuier diarrlion, a few grains of tho acntuto a*itb a ninall doac 
of morphia ih a snro and speedy romody. 

The acetate ha.* been reoommended in ehokm, vspociatly in its 
early staffs. In Lbo pni^ng from dysentery and lyphoid fever, ainl 
from tnbcrcular diseuiiD of the iutntUues, few romodiea are so nsefni. 
Tho acotato should then be combined with opium. 

It inoreases the eflicui'y of a starch injection, aged to check various 
forms of diarrhcaa ; and it may he nsed For a similar puqiosu a« a 
fiupporitorj. 

In largo doses, the acotato acts as a vraak irritant polion, Intt the 
symploms it produces differ from (hose of other irritants, chiefiy by 
conBti[iating iusMnd of purging. 

It is by no means oommoD to moot witL a caao of acute poison- 
ing with lead salts, and even the most solnblo aalta rarely cnoso 
death. 

Aente poisoning by the acetate induces the following synptosH ; 
— Dry burning acnsution in the throat, thirst, vomiting, oolio (tha 
)iain of which is generally relievud by firm premnre), tenderness 
of thi- abdomen, ohstinat<< const i]Ktt ion, dark slate-colour wotinna 
from the pn«enoe of plnmbic sulphide, great prostration of strength, 
onn))Mt of tho oxtrvmities, cold sweats, giddiness, UDmbnees nod 
oven paralysis of the lower limbs; eometiinet coma; and higln 
Colour<!d M;anty urine. In one case it is reported, that in less than 
five hours the exteneor muscles of the estrenutiee bocwno |iaralyu:d. 



^Hf l-^O SALTS. n 

and the flexors rif;i<11^ contracted. Tho eab-occteto is eren more 
poncrfnl tlinn th<! iMictnte. Tbc carbouato has no irrilttnt action. 

Tlw treatment of tiCDt« poisoning iit to promoto romiling hj Inko* 
warm drinks, to n^ve an]]>bat« of soda, or siil{ibat« of nutgiwBia, or 
frcmk prccipitntod mlptiido of iron, irliich is rarolj nt hand; the 
»touiach-|ium{i bIiouIiI bo nsed, and milk, with white of egg, may be 
givra with ndrantago. 

Small, nny, ev«n ininut« qiuintilivti, taken for a long time, will pro- 
dncD chronic l^ad poieoniDg, which mnj happen in vftrioa* ways, owinf 
to the manifold un-x of li-jid compound*. Oxide of lead is usod to 
Hiroolcn wines, the eohihlo ealts are nsed as hair-dyca, and wafers are 
often ooloared with rc^d lead. In grinding the carbonate, the basis of 
idl paints, bbIobs gre»t care is taken, the finer particloa aru inlvolod. 
SnulF is Bometimra odnltomtcd with lead, and sufliclent may be 
raalTed into the oyttem to prodaco chronic poisoning, l>r. Onrrod 
has lately namtod an in»tnictive cam of ohronie U-ml [loisonin^i 
throngb the deoonipostiou of the leaden envelope of a pAckot of 
snnff, Painton becomo jiotfoiied by cuting their mcalx with iin> 
washed hands, and so tntrodacing loml into the system. Drinking- 
waiw B(>nic4inuis becomes pnntaminnted with Imd diiwolved fmni the 
lining of tanks. Certain conditiuus of tho water either favoar or 
retard the solntinn of Imd, Thux, pore wntcr.and waters containing 
csrhonio ncid, carbonate of lime, and sulphate of lime, act but littlo 
on Iwd. Bat, on tho other hand, waters containing mnch oxygen, 
organic matter*, nitrites, nitrateii. and chlorides, act freely on tliia 
metal. Carbonic aeid is very proloctivo of lead ; it crusts the melal 
witJi an insolnblo covering of carbonate, and prutecta it from the 
further action uf the water. J 

A very small qnantily of lead in water is ade<|uate to prodoca alS) 
or some of the synptonis of lead poisoning ; even one-fortiHh to one- 
fiftieth of a grain por gallon.* But there appear to be iodividnal 
difTeretiovH in nsjicct to the action of lead, BOtno peranna becoming 
moner affected by it than uthitrs : differences snBOOptihlc of explnnfti^ 
tion,aswill be nbortly shown, Acetato of lead, in fivv-graiti doae^l 
may lie given for woeki, or ui,'vn months, witliout imlnciag lead 
pniHoning, as has been abundantly proved at the Brompton Hospital, 
where tlie acslale >■ largely employed to clievk the diarrlKva of con. 
sumption ; yet it i* extremely rare to meet witJi luy Iwtd symptomO 
eren after tho medicine hits been continued for months. ' 

The lympitnms indicative of chronic lead poisoning aro briefly — 
coniili[Mition, and it may be, im|)Aired digestion. neMimpaniMl with a 
sweetish ta«(e. A blriu lino is soon observrd nt the edge' of the 
gnms, proiluetnl by th" i"«I|ihiiti'ltc<i hydrt)fien developed fn'«i the 
torur of the teeth iwnctmling the tissues of the gums and unitiug 



tXKD SALTS. 



Ui> 



m 



with the Iliad, [unniiig it black snlphide, conaequentl}- tlui bine lino 
is most mnrkod in porsoos who do iiot clean tbcir teeth. It is soon 
only at tha edgu of the gxuna, where tbej come id contact with the 
teetb ; where the teeth aro absent, the blno lino is absent. It is fintt 
obeerrt'd, and Is alwu^a most marked, in tbu gnms in the nt:i)j;hbour- 
hood of the iocisors. Thi» blue line is one of the earliest iudicatiom 
of the cIToct of lead, and is one of thu slowest to disnp|icnr. Dr. 
Garrod say* tbi* bltio lino i.t iierer ftbsenl if then; are any teeth, and 
that it laay oKt«nd to tho whole gnout, and noniotimes it i" obscrrcd 
on the ]>ai-ts at the lipn and cheeks oori-eiipondiug to the gama. The 
nntrttion is impaired, th(> skin bcxwmcB very sallow, and soonor or 
lat«r severe colic, n-itli obntinato confitipalion, and sometimes vomit- 
ing. Beta in. Colic may occur without any iiremonitory signs. In 
lead colic the abdominal widla are retnu-ti-d, and very rigid. Tbo 
pain, as in acttte lead poisoning, is mostly eased, though it is some- 
timos aggravwtcd, by firm pressure. The pnliw in Nmnl! and inooro- 
preesible (high tension). 

Frt!(|nont and oftvn seven.' crainpn occur in tbi^ onlvvs, snmctinios 
in the utems, penis, and scrotum ; and sometimes the patient is 
hanu(»i.-d writb pains about tho joint*, gonorally of the extramitieai 
increased by movement or wet weather, and closely nimulating rbuu- 
matac paitu. 

Scimoticnes paralysis takes place, generally aiTocting the appcr ox- 
(rvmities and the cxtcnum of the arm. 

Tbo iDe«e)e* Gnt Bfl«ct«J aro thotc ntpplivJ b; tbc nnuculo-iijlnl Dtrw (portenor 
interoMMOi) in the (Dmiui, and oipNialJ; tlie ci(«tuar aouiaiiiiii* illgltamm. Tb« 
aapinator lonfiu tbareton sBtukpn. Tbo tupiiialoT louiua it alniost alniiji ■<jp|>'i*<l ^ 
a bnoeli riam tho muwulo-ipital n*rtc Man It illvld«a ialo llio pnatuior jiiMraMoai 
add ndUl Dcrt>^ TliL* foot ofua cnnbtci u Bl ante to dSurimlokl* belTtn Im'l- 
pDuoDing, and pmljni frDm dUcHO of tb« taunnlo-ipiml nerrr. It th« lupinator 
laiij{ii> u pualjud, tbj< taut poiota to tht diwan o( the muMutu-tiiinl arm, and th*n 
ths )at»]fiU in aot du« ia lead. If ilii* didicIc ft not I'anljKd, tbui tict *ho«a that tlio 
dlMnir l« llmltol to the jiOiUTinr iiil«ni«K>uii, aud Ibal tbe panljint b piobablf doe to 
ib« BOlion i>f UiA. Tbc coailiiion of tbe lupiiutot toDKua ia <aualj t««lcd ia the [ollo«- 
ini tnj. Ki(«iid lh« panLljwd lormrm on tho tnlilv, oitb the radiai ni'Vardi, tlicii 
fr«H da*n Iha vritt, ami tctl Ibo lAtioiit to Ir; to raLt« it trom tbp table. Tlio 
(upiaalor lotigiu, if not punlfud, 'nomci'Miilj besomei hud, oosuaotod, and (tand* 
onl |>i«tnliioDUj'. IKrb.) 

The mnscles of tho ball of tbe tbnmb waste greatly, tuul in 
severer cases tbe deltoid, and even the muscles of the nock and 
trnnk arc similarly affected. Indeed, in the worst cases, general 
paialysia may occur, with wasting of tho muscles of the whole 
. botly, oven the voice becoming wwk. Tbe paralysis mostly affects 
TOOlion onlf, bat sometimes tJiorc i« nlito lofs of sensation, and nlti- 
niAtely greet loss of electric excitability in the musclca. Epiteisiy, 



250 



ttXO SJLLt^ 



(loliriata, c(mrnluon>, or ooma, muf dcatroj the peti«Bt ; bat tlMth 
from clironic lend poteoning i« nncommon. 

nn uamittiM «MUd, CNjrltk'Nd ar *biti«k and toucb, *iU MtuIfbnU* Iboiwh 
of lb* IntoiiUtkl cMUuctiTc tiuoo. TboK (baagtj arc tirellu (o tboM «kitk oe«ttr 
in Ujnr; lo nerrw, la pngnnre ma&rDlat airophf, ud in i[>iDikl {isntljtU <if (btlilreo. 

no* do«> had iMdnn panljria I On tbi* point Tariaii* rivn an beld. Some 
DalatalB (bat lead dbMlly ailMU ib« matclH ; Mben tbkt it amMi ooUilion Vr 
HtltUf lUmg MntnMidit at tbo blood-nMcbi nppljing lbs iiaMed naiclci. Tb* 
f-iiiUiim of ibt " racliDB <4 JajtemUM," h UtUd bj alaeUidVi ibov* Ibat iba 
affrclian i* Mated aitbac In tbn necra at In (bt aplnal wnj ; aad prttablf in tb* ifiiial 
cord, lor Ibc rcMtioo o( dtgMLenlton and alioph]r pnmu oucU; tUe budo <iiiam a* In ^ 
tilt apiaal panlfria ol cUldna. ' 

Tho cnmpa are not oonlined to tlie mnscl«8 of ibe exlrcniluM. ' 
Tbo tQtMtuuM arv »liui kITucU!!], M>iiiptiinoH altaoai tliroiigliout their 
Ivngtfa, but gciMtrnU; only » liniit«d extent is involvod. If tfao 
fingtr ia piuwd uj) tlio rectum, IIia oontmctions con iwDuitimeN ba 
fait. The blood- Tcsm^s, liko otbin- parts of the bodr, are said to be 
subject to ommpN. The kidnojr* w haad to bo cirrhotic, indeed in 
mnnjr fntal ciwKw, tluiro is more or leafl general flbroBu. 

The colic ta f;;vuvrHlI,v di'puiuK'nt <>» <.-ani)tipntion ; for when thin i< 
sot right the colic gonontlly ditappaara. 

Tke inlluence of load on the vntte« in ttio l>tood is nioet ungnlar. 
Dr. Qurod, in hia roBMrkablo invostigationa caaeendBf; (font, lias 
elacidatcd thia rabjevt, and Hbowii tliu intimate ooameotion vxiittiu^ 
between load poisoning and gunt. In gout, oa this philosophi*^! 
obMTVor has aboim, (ho nratcn, probably with incrcnMcl fomiation. 
nn retainod in tfao blood. In gont, oBpoclally daring the acnte 
attacks, aoarwtj' any nrie aeid ia to be found in tbo nrinei while an 
abnndanC quantity ta detectable in the blood. The nrat«s diEsolTiwl 
in tho blood uunifevt npeoial affinity for porticmlar HtmctaKni, n* ibe 
^m cartile^cH, baraw, and fibrous tiaaneit, iMitK-oJarly of certain ptrts. 
^H and dnrjng (he dopoaition of the niaUM in the joints, aoutv inHoiniiui- 
^H tioti itt oxoited, and thia consiitutvH i^itit. (See Colobicuin.) 
^H Now, lead checks the aeiwration of urates from (bo blood by the 

^H kidneya, din)iiu«hc* the nrio Moid of tlw urine, thuH grmlly angnwnt- 
^H iog that of the blowl, and (bua we have the pathological eondilioo 
^B which excitoN the smuty inHtunntation. Dr. Oanred hu forthnr 
r^ abowu— and fain ax[)criuuoe ia oaTTul>ur»t(->l by all who hare iure«ti. 
^^- gntod thia sobjocl — that gout very frvi]ncntly oocinra among Ivad- 
^H worker*, and that gouty [Mtienta often exhibit the chanicteriatio Uttu 
^1 load lina on Uwiir gntna. 

^B Tbeiv, too, in tho fact, in further onnSnualion of lit. Uarrod'a dia. 

f cororiea, tlini. t( to a gouty {x-nKin, trvo at the time Innn an acute 

^^- allaok, n Mill of lend ia adininiatenNl, it dorelopM* atmta gonttWlth ila 



I 



LUJ> SA.VTB, 



251 



ncconipanpng sjmptoma of severe pain and high fovor. Tbo untlior 
iiM i«[H.-at<slly veriGod this fuel, lirst pointod out by Dr. Gnrrod, 
whiob affords an explanation, in part at least, of titu good eJTeuts of 
iodide of potassium on gout, aluoo, as we linvc shown filmdj', tbJa 
»U i>rcimutcM the nxcpiilion of l«id. 

Lead is used for a variety of purposes, but chiefly foe its netring«Dl> 
action on Iho tiNgu<!ii, an in profaso disulutrgcN of the niucoiui lanm- 
bmne, from tbe lunj«s in bronrUitia, wid to check bleedinff from tbe 
now, Inngis, kidneys and atcrn^ 

It bus been conjeetnred thzit lead in Brif;bt'a disease might check 
Uie vncapo of nllmmen from tliu blood, and tlicrcforo Iwiron tbo 
Mnosnt of it in the urine, and George Lewuld lias published some 
expertmentA inatitntvd witli a view of tMtingr ^^^' point. He dnr« 
not numtton the form of kidney dlcease liis patienta suCercd frutii, 
but it waa probably tbe pale, Subliy, fatly kind. EIo obsorrod at the 
waoui tirato tbo inHaence of tbe lead on the lunonnt of nriue voided. 
Tbeee experimentit, too few porhaps to decide tbe qncstion, abaw»d 
tlutt lead constantly diminished tbo albumen of tho arinu, tboagh 
only to a very snuill extent, namely, to about nine or ton gnunc in 
tbo tw«nty-four liours. The diminution appcnivd to bold no relation 
to the quantity of lead administered. The quantity of water was 
Ktmtilt&neouBly inoraooed on ui nvonigo by 200 c.c. in the twency-foar 
hourt. Hero tgain. the tncrtase bdd no ]>rop'>rtion to tbo quantity 
of lend employed. 

Imd has boon found in tbe lungs, kidneys, spleen, livor, and brain, 
bat tbere is no evidence of its poawanog an ei())Coial aflUiity for these 
port*. 

M. Paul, who bos investigated tho inflocDco of bwd poisouiiiK ou 
the fcetns, nya tliat women working in lead Eaotorios frcqnrntly 
Abort ; and that tho father mity canao abortion, even when the mother 
U not a load-workur. In 1^3 pregnancies, aeventy'Lbrvo children 
wer« bora dead ; nnd of these, sixty-fonr were nbortiona, four |ire- 
matnro births, aud five bom at tho full IJme, Of tbe fifty bora aliva, 
twenty died tbo lirst year, eight the seoond, seven the third ; one 
later i nnd only fDtirt«en rcAcbixl tba ago of ten. 

Wo know but little concerning tbo elimination of kod. Only a 
littlo lead pusoa off with the uriui! : iodido of potassium, however, 
ioereaBM its elimination. 

It is a farther qnostion wliulbcr tho metal is sopomted by tho 
kidneys with tbe urine, or by tbe muoons membraao of tbo urinary 
trai;t. On theoretical groun<tN it is diffioiilt to imogiao bow coelala, 
fxisting in the body oa albuminate, can be eliminated with a non- 
albuminous NOcrotion ; motTOVvr, after tlio administration of lead, as 
aftor tliat of iron and otltcr metalii, an increased quantity of tho 



252 



XmU-n OP SILTKB. 



metal is detectable in the uHno; an int-nMued amount of inaoaB too, 
KimuItaBoonslj with Kigns of irritation of the lining; membraiift of 
tUo bladder, even to the oxtetil of imludrg a ontarrbal oonditinn ; 
wlivnoo it ban beun inferred that ilie mttal is Be]iarat«d with tlie 

rtnocus secreted bf the mxiooua miinbmnv. 
I 
: 



NITRATE OP SILVKR, OXIDE OF SILVER. 



Tbr Kiliibla preparation of silver, when [ai:ited on Hie vk'm, coloara 
it first an opaque wbit«, which changes gradnally to brown and 
hlad:. The ni»]>lication of a itrong aolutioo will i)roduce vcaicattioin. 
NitnU« of silver is sometimea applied as a destmctive caostic to 
warta and other escrciKoncot, bnt ita action iKing too xaperficial it is 
nselees for this purpose 

Applied to tlie abrmlud akin or to iviree, llio solnblo silrcr Mlbi 
form an albniuinate whieh coats the surfiu^e with a thin layer and 
I)nit49cta the tisstie beneath from tlw irritation of the air. The 
nitrate of silrer acta aa a powerful uxcitant of the tissues and 
dentrors them, l>ut only very mpcrficiiUly. It ia frenneDily applied 
to indnce healthier growth in nnhealthf and nwiluan nlccn, fp^"? 
ranch amarting pain, which, howevor, soon pnssca away. 

Like most other sdnble motallii! [irepAmtioniii. the nitrate causes 
eoodonMtion of the timun a» well as conlmction of the blood- 
vesels. on which account it i« maid to slay hoMnorrlia^ ; beinft liable, 
however, to excite mncb inflammation and pain, other blander a«trin* 
(•ents slurald ftnt bo trieil. Sometimes it is naed to obeok tho 
bleodinjr from leech-bites by (onchin^ them with a stick of iittnto 
of silver. 

Nttrato of silver nill prevent the pitting of emalUpox, if caofa 
veeiete ih openiid as aeon aa formed, and the raw surface beneath 
toBoho<l with n solution of tlte salt. Dr. F. Itowen has remrlod an 
inil-nictivo cace sbowini: the eflttiM'y of thia In-ntmcnl. He troatml 
the vr«icIeB on one did*.' of the face and neck in the v>ny dnwribed, 
Iraring untouched the Tcaicloa on the oppcoiite vide, with the rMolt 
tliat on recovery the untrrated eiile was deeply pittol, while the 
oppoaito side remained nmooth and scarlMB. l>r. Uowen, who bH 
devot<-<l marh attdnlion to this gubjivt.iiinte.i thnn a iitirwi fan eadljr 
carry ont thii [imeeNs. At an early t'laico of the eroption, at tfaa 
hiteal OB tiui fourth or fifth day, he punelnrM the vesicles witli a Rnc 
Dwdle dipped in n solntton oomtainiog twenty gnina of nitralo of 



MTUTE OF BILTBO. 



2S3, 



gilTor to an ornico of water. Mr. Higginbottom finds it unnooeuaix' 
to puncluru llm vcaidun, niid Kiiyit it in cnougli to piiint (he skm in 
tha manner roi^ouuniMidecl by him in erysipolas, wbioh Kudnes in. 
ilammation and provont; suppuriitlnn. 

Bod'Sores are best prevented hy painting the tbrtuk-ncd but nn- 
brokuu «lcin, lut Moon ng it bocnmi-K red, with a Rolnlion of nitrnte of ' 
silver (20 graiaa to hu ounce), wiib tbo olTecL of diKpnming thol 
rt-diu-KH, liardsning tbc skin, and pntrcnting tbe boil-aoro, anlesa, aa in 
tiie caae of paralysis, tbere is a givat proiionoss to tliis leHion. 

That upccica of boil wliioli, bvginning first as a. papale. maturates 
into a puHtule, and infloaiCH and extends till n larf^e dead eoro is 
prodncc<l, nmy, it is eaid, be arrested in its onrly pnslnlar stage, by 
]wiiilinK it c)vi-r at its vei; oommencement with a atratu; »i]ulinn of 
nitrato of i^ilvcr. 1 l>ave had no oxporioncc of tbis mctliod ; but of 
the beneficial iuiluenoe of oollodiou on aimilar boils, to bo niL'ntiuned 
in ikUothoT place, I can spcfik with great coofidonoo. 

Nitrate of ailrer will nrrent herpes labialia and tlie rexioatioa of 
sbingliiH, if tho warning patch of erythema is painted over, bcfora, or 
as soon as the vesicles be^in to form. 

Wo aoinotiiDm moot with a pAticnt with a patch of lichen, the siu 
of the palm of tlic hand, afleoting almost any part of the body, tho 
irritation from this pati^li being sometimiw so oxccsaivo sh won to 
break the s]e«i>, and injure the health. The painting tho patch with 
tlui nitroDi other solution of siilvcr everj- day, or occoud day, a-i tho 
itoliiug may require, will gmorally euro this alfoction. 

Limit*d patclios of eoecma are sometimes bcni^lUtKl in the samfl 
way, Nitrato of silror proros most son-ioeablo after tho weepinffl 
stnge. 

Tho ooouional application of niti'ato of silver or sulpliato of 
copper, is servioeablo in psonojiis of tlm tongne and ij)iitK>0H mem- 
brane of tho month ; but if it depends on syplulie, luercarial npplioa- 
tion* are be*t, A wmk eotnticn of nitmto of silver, gradually 
strengthened, is staled to be usefn] iu tlio sujierficial kinds of lupnit. 

Higginbottom very strongly recommends tho local application uf 
nitrate of silver in erj'sipalas. No agent, ho says, is so safe or so 
cfEcaciou* m subdiiittg externnl inltnminations ; btit ho points oubi 
that the success of thi^ treatment depends entirely on Uiu manner of 1 
condncting it. Uo directs tho skin to be wull wn^hcd with son]> 
, and water; then with simple water; then to bo wiped quite diy ; 
I next, a Kolntion of four scraplos of the brittle Htick of nitrate of 
Hilvor, in fonr drachms of water, is t<> bo applied two or three times 
to tho inflamed surface, extending two or three inches beyond it. 

Kitnte of silror often cnros tho intolentblo itching of pruritus 
pudendi A largo camel-hair brnsh, ^satuntod in a solution con- 



2U 



Xmtl'n OF BILTER. 



tAJntRf^ from two to fivo gnuns to tius onnoe, sboaM be jAintMl 
tlirnc or four timea a day over the ralvn, nnd 1w thnut up to the 
08 ■atfri. A stronger nolntion used l«aB freqnontly will noC answer 

MO Wfill. 

A wcttk solntion of nitrate of silver often relierea pruritBs aai. 

Pniritns cntancflns of Hm montns ancUtorins, occurring vitbont 
nnf miption, should be Irmted by tho applicntion of a Mtrong 
eolation of nitmto of ailvor, carcfutty aroiding the membmui 
tjuiponl If the itching arian from oDdue drjrnMii of tfan tmr, 
^u deficient sccrotion of wax, alinond oil or glfoerine should 
first be tried. 

When lued as lui outward applicittton, nitrooB «ther is hy hr the 
boKt< nnlviiiit of nitrate uf silver, for, hy diwolTing th«i fnttjr nuittora 
of the skin, tbia solution forms a uniform layer over the surface, 
unlike a vratorj? one, which runs into drop*, leaving the inter, 
laodiata akin dry. This eolntion is not arailablo iu erysipolM, 
as nitrons other will not (tiAtoKe tliu cjuimtity of nlvor required. 
It is impoTtant to bear in mind that a nitrous ether aolntion anta 
much more tttrongly than an aqueous solution of oerrmpouding 
slrv-ngth. The etbor solnlion must, therefore, be made weaker, 
flvo to ten gminti to the iinuci) bcinc^ c^tiemtly strong enongli, 
Vive groins to the ounce is suffiuii-ulh' Htron;- fer thmteoed bod> 
sore, a stronger solntJon often blistering, particularly on ai>p)ytng 
MTvral coats. 

SolntioDS of nitrate of silver are used to blacken the hair of tUo 
luiad. Tho hair is first washM witli the solution of nitmte of ailvor, 
and then a comb, dipped inUp a folntinn of tmlpbido of potassium, 
is pnnted tbrounh it ; a prooesa ranilUng in tlu prodnotion of a dull, 
InslrelesB, ghastly, bbck-blnisb colour. 

In obstinate tineA tarsi, tlic solid nitnatouf silver stink is soraetimos 
jmmeA over tli« edges of the eyelids, Brat removing th« eyetuhi 
wtd th<i scmIx. 

In conjunct ivitis, a few <lrop8 of a solution of nitntte of silver, 
Tiuying in xtningth, is injiertetl with the aid of a quill several time 
■ day into the eye, exciting in lite mombrano a hi-althier inlUmms 
tioti, which soon Kuhsides. 

Tlie nttnto may bo applied to ulcers ef tlie month. ^V1ta»3 
a wilder application than the ordinary caustic is required, it is 
ooovenicnt to use the sticks compoMxl of equal parts of nitrnt 
of sllter and nitrate of potaali. 

Tbo solublo salts have an astringent metaltio taste. 

In tlte early stsgra of inflnnunation of the tliroat, wlien tha in- 
flamnatJoii b superiicial, and there is only a little sttvlting, the 
npplioatioD of a strong solution, or of the solid stick of nitisl 



MTUTK or SlLVBtt. 



255 



of ailver, sabdaee and somelimea eren extinf^iuBliuii tbo inBiuanuu 
tion. 

In clirouio ton tbroal, u-ln-u Ilia tiuue« %vo rolikxiid nnd coT«r 
with pQs, solntiona of ihe uitrate are scrvi(»fible ; but tlie nnUio^ 
dow not tliink tbo^ nro mipurior in luij \ny to strong lutriiigeiit 
and nnirritatiDg ftpplications. Ktcii nlcora we beat tnotad bj tlio 
glyoorine of tanniD ; bat if in ii Mloaghing and tiithwltbf condition, 
then tbe irritanc nitntic mast be preferred. The nitnte of nilvcr i« i 
also applic'J with dotibtful benefit ia diphthoria. 3Iost aDthoritieai 
are agreed tbat the application aliould be limited to the inflamed| 
potoheei for if appHiid twyoiul tlioir area, it exntea an extennii] 
of the inflammation, ou which the false membrtuio may nadily iai> 
pbuit itsolf. 

Nitrate of eilrer, in powder or iolntion ia aometinuiH applied bj 
mMuui of a piofaang, briuh or tipongo, to the ohroaically infiamod 
lar}-nx, as in phthisis; or Bolaliona of nitrate of cilvor. in tJie pro-, 
|Kirtii>n nt gr. ) tii gr. v to the obdos of water, may be bnmght to' 
Ivar on the piharynz and larynz bj the apray-prodticur. 

Dr. Horace Gn.'en, inject* a solution of nitrate of silver into the 
traehea in aBthtna, bronobitis, and pbthiiris, after dcadflain<; iho 
seiuibility of Uio glottic, bjr applying l'> it for one or tn-o wb 
a wlntion of nitrate of silver. He passes a \o. 10 or 12 cathetor,1 
whiob prodaora only a Honsation of warmth, thioo^'b tlui i-ima 
glottidJs, don-n even to the bifarontion of th» ImcUoa, and inJMta 
the aohitioii. The late I)r. Unghee Itonnetl. who oodorvnd tliis 
troatmant, injrrlod citliiT tvn> <tinahiDa of a solntinn containin;; hiilfj 
a drachm of nitrate of silver to an ounce of water, or evi-u linlf aal 
ooaco of a solution conaiitting of forty grains of uitrato of ailrer, to 
an oanoe of vrntcr. While intTodndng tho trathoter. the head isj 
thrown back, and the longnc drawn forvranl, whun the iaatnuneal 
gltdM aloBff the laryngeal Hurfnoe of tho epiglottis, which is noarlj 
insOBsible. thrangh the ritna glolttdix itaiOf. 

Sponging out the throat with asolation of nitrate of silror, greatly] 
diminishes thu riolvnoe and frHiucnuy of tho iiaroxysm in whoop.J 
inif-oongh, renders the congh bnt half as freqnont, make* tho fltai 
mnob less Mv«n-, and enabloa a cliUd luuiutaed with broken slecft to 
obtain & good night's rest. Bnt thoro is a formidable dntwfaaok to 
this treatment ; for the application gonemlly pnidnocs, especially 
with very yonng children, so violent an attack of coughing, as to 
excite fears Icet feiifTociitioo ahould (inime. Instead of Hponging ihu 
throat, the nitrate of silver may l» a]>pliud in thu form of Hpmy by 
tbo atomiser. Very young children, bow^vor, cannot bo induced to 
Open their mouths, and allow tlio inhalation of tlie spray ; hcaoe it« 
OM ia restricted to ohildreo more than two or throe vcsra <dd. Those 



256 



5ITUTB or SltTER. 



npjiUcstums, being apt to excite nteluog, ihoold be omploynl wlicn 
Iho stoiDttcli iM cmptjr. 

Any part of tito salt liaring esnpod conversion in tlio month is 
oluaged into tui nlbnratnxte vrhcn it nntors tlin ntnoutrb ; nnil if imfB- 
cient dlbnnMin is not prosont to effect tkiii, tli« Kaltftttackstbo mucoos 
nujinlnaae, Mid exciteit activo inUntniitttion. Tbu be«t uitJtlot« 
far ft poisoDOUH doM is common nit, k fmot useful to bear in tnind. 
if, M tomediaes liappena, tbo iwlid stick of iutr«l« brcAks off nnd {• 
BWftllowed. 

Nitmte of dJlver ftots u ui imtnnt tn tho ntomacb, sad mtiy 1x> 
used in prPciMly (lie Borne elasaof casea for wbicU nrM>iiic i« iippltc- 
kblo. It often checlcH tba pnin iind Tomiting of chronio jnllitiumntion, 
of chronic nicer, iind even of mnccr of tliis organ. It sboald not be 
giren iu tliu form of a pill, but in Eolutioa. 

Tho Dttrato actii n* an astrii^;ent in tlte tntcetines, and. in contmoti 
villi Kuveral other metallic preparations, may bo nMd in diarrhopa. 
both of the ncnte and clirttnic kiiul. 

Peptones readily diHtolve llui nitrate, and tho solution docs not 
oooftnlste albumen. Proliably it enteni tlie blood in tbls form and 
ec^locts in tho r«d corpuscles as other metals tend to do, if not 
speedily deposited in the orffuoM or sepni«tcd by the •ooretioas. Tlie 
red corposclw are said to become paler and tlie hiemoglobin to be 
conx'crtcd into lucuialin. ami it in conjectunid that this cluuigu ex- 
plains tho slig'ht fall in t«mpeTature after large doses of silver 
salts. These salts, being absorbed, are snppofcd to Iw n>dnng«ni to 
tlie tissuM to which thoy are oonveyedi but this is a doubtful aup- 
posttton, and they are nerer uki^ t<i obiKik either bleeding or NocrctioD 
from the distant organfl of the body. 

In poisunons doses nitrate of silver excites in animals oonvaltions 
nnd paralysis, probably central in oriftJn ; the convnlstons, bciiij; very 
similar tn thow prod»ce<l by Htrychnia, are cxnit^il liy the \t*et peri- 
pheral irritation. Death is »aid to be due to asphyxia, and the lantcs 
are found congetrled nnd wdematouji nud tho bronchial tnbM cUokod 
with mucus. Injected into a vein nitrate of silver dcatroys con. 
tmctibility of the cardial! muscle. 

Cliroiiii: |K>iiioniu>- by nitrate of silver producr§ kwH of appetite, 
imj^red nutniiun, albumen in the arinr, rapid and imfnilnraelion 
of the heart, and after deatli ther« is foond geiwral fatty det^nem- 
tioD, especially of the kidneys, liver, and heart. 

Both tliv oxide and nitntle aru employed in chorea ami eptlsi) 
apparently with occasional benefit. The oxide has bavn given to 
oheck profa** sweating. Nitrate of Hitver is sometimoa verj- uwcful 
as an injection in acute and chronie dysentery (Jj to three pints of 
injeotion). If a<lminisl«red loo lonf , thoao subatMWM, in some (am, 



HEItCt'RT. 



257 



probiibly lui tbA rcdnood metal, are depoaitod in all tho titKncii of tko 
skin, except the ret« malpigliii, ilikI most abundantly w)ier« tho 
■kin tx fine«t and moct TMcalar ; hut, onoe d«po«it«d, the mutiJ 
renuuns aa a permanent discolomtion. of a deep leaden fane, mtlior by 
timtt or troatmont irremorable, nnleaa !t Hhonid ynxtvo trno that larfp 
dotte of iodid« of potnniani, as has boon lately stated, will waab ont 
tliiaitain. Dr. W. Pcpjicr fiiiila that thi- ntaining of the tfkin !» 
alwaj'R procodcd bya dnrk line upon the ^miH. Silver appears to bo 
ctitclly eliminated by tho intoittinca and bUe, very liltlo escaping by 
the mine. 

The nitrate, in aolntionit of variouK Btrangtb, la uatd u an injeo- 
tion ia gunorrlKi-a. Some advocate a very strong Rolnttoa (twenty 
grains to tho oance), avt'iriiiK that in many instances the disease may 
at onoe be oat short by it ; othora prefer a mnch wtmker solution of 
MM or two grains to tJie onnoc of water, repoadnj; the injection 
sereial times a day. 

A niatton of glycerine of tannin, half the atrength of the phar- 
iraoopaetal preparation is, 1 believe, a better injection for both 
gonorrhoMi and gloet, ttmn nitrate of silver. 



MEKCURY AXU ITS PREPARATIONS. 

Tar. ealta of mercnry possess vety rariniiB pbyr<ic4tl as well as chem- 
ical properticM ; but as in every instance tiji-ir cflcct on the system 
ia well-nif^h tho same, ])robably all murcary compouads nltimatcly 
assnme tlu> name form in tho blood. 

Tho nitrates of the oxide mud saboxido arc esdUtrotio ; but mncb 
of this action is dnc to the free nitric aoid of tlia Bali. They are 
need to remove warts, condylomata, aiul oth«r slight cxcroBccncn. 
^Iitrcuris) apjdications will completdy allay the anooyitij^ it<:hinK of 
certain skin aSeutions. Solutions of bichloride, Unck-wash, yitllow- 
waab, or DMrcnrial ointment, may each prove naeful, but the ajijdica- 
tion mast be k strong one- Troimcan highly recommcmls lathing 
tlte part with a solution of abont twelve grains of bichloride in a 
pint of Tory warm water. After much experience of thewe apjiUoa- 
tiona, I believe that far the best application is an ointment, composed 
of a dmchm of calomel to nn ounce of lard; hnt thi« ointrntrnt, in 
commuu wilh other mercurial applications, is not nseful in all kinds 
of itcfaiug; for instance, it in unavailing in tho irritation of urticaria 

Calomel ointment often immediately removes the itching of pro- 

s 



as 



HERCrET. 



riUu Mii. TlitH irritntion ma)^ be doe lo nabcs, as peomsis. licben 
or ecxoma, or no cnii)!!^)) ronr bi> ^Hsiblo, }rol tha ointmi-nt will )>roTe 
otIDttll/ HBcaciouH. Sometimes iKe itebiof; ia fell nJong tlio rsjib^ 
betwocn llw anns hikI BCrotnin, and niaf bo due to littlv muml ii|iot« 
looking like paoriosu, witb Uie Mealeit wantiMl ofl. Tliia form also 
f ielde to tho ointment- This application is less froqnimtljr uxvfat in 
pruritus pudundi. In obxlinale muhm of jimritnit aui and pruritm 
pndendi. blietcrt to tho thighs, or the application of a fuw U)«cbint. 
•onwtiBiiaii afford relief. 

The ointmvnt in manj- inetanoeii improTes tbo nwbM tbonuwlvM. 
bub tbiK in in some mnutoro due to tbc cMMtion of Ibo ■CTatobioy, on 
tbe disappsaraoce of tbeili-bin;{. 

SonwtimM a lit! to NC«l>l>inctw of the head, looking tiku mild Mxomat 
oooitrs in ohildren, acoompotnied bjr a degree of itcbing, sufficient to 
prevont sleep, and to cause eonstant nwtlcnneBfl. Tho calomel oinl- 
nuint 8])oedilj ap]icaiH!a tbiii irritation. 

The innnctioD witb calomel ointment, allaja tlic distressing it«bing 
of the Mcalp KOmetimoA aecoinpanjing' intyriiuiii. It maj bo profitably 
added to other ointments used for the removal of pitf riaas, as oxido 
of moToorjr or of lar. 

It mny Ik> objectod that so atntnf; an application of mcrcnry, espe- 
oially M'iien applied to »oft and aliMorbing parts, mt tliu inner mirfaeo 
of thn itilvh, anil Um skin around tlie anus, mnst snrol; pradneo 
talivatiou. No donbt care sbonld be extrcjited, and no more ointoimt 
uaod tluin is needed. Tot the risk of salivation Menu to be cxtreuelf 
ulight ; for, witb a rer^ largu expcrienoe of tlu) ointment, I bare 
never seen sativntion produced by it. Fro[ierly applied, a very email 
pieoe of ointment in gencmlly enlBcicnt to nllaj Uw irritation at oneoi, 
and even to remove tt nlto|fether in a tevr daje, a]tboui;b it ia rarj 
apt, aftvr a variable time, to rrlam, when it again yieldn to a renewed 
employment of the ungnenL Ita ^nrntefnl eSeots are often aJmott 
inirtantancnnji, thoagh aometinMW it tnketi a few days to give emao. 
Haring many times seen it (mecced when other remwiice Iinvii enlitvly 
foiled, I nm convincod of the Tntoe of ihia application in Ihcae haniM. 
ing and pervcTBe dinouea. 

The white itreripitaln, or nitrate of mcrcnry ointment, or rwrrosire. 
snUimate waah, will dcNlror the vanmiH kinds of lioo and thnr ntia, 
which infest difftnvnt parte of the liody. for lice on the pnbes, it is 
noovMory to apply the ointment or lolinn to the iwrotnm, bairon tba 
poritUDam, and umand 1)10 annti. Tbu nits ctin be dislodged by 
wnahing tlie haim witb opiritM of wine, whtob dinNOIVM the ginoy 
matter so strongly attaching the nit to the liair. Tbo l>ody*lousa 
may be killed hj iho casential oils, na lb* oil of roaamary. vr bjr 
powdemi pyrotbmm, or by an ointment of staphiaafrria. Throngh 



I 
4 



w 



the gn>nt)i)I>.iiK fi-u- nf indii«iif' nliTMion, Eomo pi«fvr tbeae to 
mervwial BpplicatbaDS. Tb» nndsr linva aboald be Imilod to dotrpj- 
maj hiddcm lion 

^w irritant oiatmeBtfl of nannaj kro nsofnl in that obtitliiAta and 
dtrff^ring ftfTcctum, tiara cDkris. The ejelasbes should be cut 
short, and the ointment, cither of nitnilo or oxido of nKrcniy, ■pptti-d 
night and moniing, piclcia^ oS the seahe beCora e««li dieasia^. It is 
a oon u non practice to dilat« th« tto^Bcntnnt hydmrgjrri nJtntis irith 
txtaa fbor to itix parix nf Himplo <nntiiieDt, wfaetlner used for nubiMt nr 
tinea cUtari^ but in many instanow the nndilalr^ ointiiieat is best, 
and it twldom reqnimi to be rednoed mun; than hnlf tlie oflicinal 
atrenglfa. for the failnre of tKe oiatniinit in eciei&a. psoriasis, liohea, 
tinea ciliaris, is often do« to ita emplojrtncnt in too vr(«k a {arm. 
Mr. Hatch in sou. and others, nsaerl that e|>ila>ionenssi«stheapeedi«til 
care. ShoatJ ih(>se stimalatii^ applicalionn fiiil, otbcnt norepowvrfnl 
abonld be tnetl, a« nilmte of nilrer, or snlphate of copper, the laat* 
named salt being praforahio, as it giTca btee pnin. 

Patchcft of obctinato IJoheu and peoriatia, especially of the hands, 
eren wban not sjphilitJCi will nnmotiniea jicld to mevcBry ointment 
when milder treatment fuila. The calomel and nitcnto of mvrcavy 
ointment may bo mixed, and tlio additioB of tar ointment sometiinvv 
incfcaaus the tiflicacy of thb combtuation. 

(Striae ointment is aUo very nsefnl io some caxcft of eexctmn, won 
in the miepinj^ vtagv, if thera in but litlti< inflnmmnlion, b«t it is 
ospecJatlr OMfu! in the sta^ of deequamatiun wltun tho skin haii 
healed. It in murkiHlly norviomblo when ecioma afFects the baiiy 
parts of the face, often oaring this obstinate funn when »th«r rciae- 
dtM have lieen tnv<l in rain, and even whim it foils to core, it gene- 
rally in KTvnt part subdnea the disease. The snnui ointnwat is 
very benoficial too in pityriasis of tli« hairy parts of the face. lu 
botli ecaema and pityriasis it is better to mix it with tar ointnunt, 
thoagrh this oomlnnation is soraetimua mora irritating than the 
simple citrine ointment : not unfreqnently this mixture cannot lie 
tmmi', whilst tho citrino ointment, pure or diluted, proTm very 
useful. 

la the early stage* of ncae, a lotion composed of conosiru BuUi- 
mato, one ]iart : alcohol, eaan^^fa to dissolve it ; waliT, 100 ports, is 
paid to Iw of nso. A toaspoonful is to bo adilc-d to n quarter u( n pint 
uf water, uod tho face sjKin^ced with tlw lotion nixbl and mominff. Tbe 
bichloride lution, aftor a time, prodoccs a " scalin«es and hurdiivM jof 
the cuticle." 

Ricblorido of mercury, one of the best paraaiiieidex, in useful in 
favns, tinea syooeis, linva toDsnrans, eczema marginatum, and pity- 
riasis reniicolor (chloasma). A lotion containii^; two grains of 

6 2 



260 



HIRCVBT. 



bicMoridc ta &n onnco of u&tfif ia froncrall^ aufBcii!&lIy alrong. Td 

'btvsR, antl tiniTii kji-okik, :iml tinLti ton>-iinin)(, tlit* Intimi shaiiKl Ixi Kp- 

, plied after cncb gpilation, and Bbonld bo continued for M>me dmo 

aftwr epilation i« diiniontinucd. TIiih Ircatmont in higbly ttpolco 

of b}- McColl ABd«T§on. 

It ia tnngbt, on liigb nathorit}', tbat tho npiillcattou of itiorom 
ointment in pitmnyi^liiik is rcrj naefol, repeated for ten minutud rra 
hour, applrinff ponlticcs at oth«r time*. Dr. Scott umi Mr. ^(cComuu; 
Ixitb report ncvonl atrikinK o^cs o^ cnroB by dofitinf; uitr»U) o( lua4 
OD tiie dis««wed tiaanes nigbt and morning. 

Hurouriiil prcpiimttonH aiv UKcd aa loc<d applioktionti in rlirnnio 
influnmation; for iuBtancc, Scott's ointini.'iU I* often emjilojcrd ia 
cbronic inRammatiun of the kii«c-]oint. Mr. Jobii ftlamball faa 
recently introdaced a n«w morcnrlal prcpnnition, olcnlo of mercnrfp^ 
vufving in nlTcn^ftb accordii)^ to tlie needs of tlit) cum, and mrioniilf 
eoiiibincd vritb other rcme^ire. Mr. Mimbairn papor is bo prnetic*! 
nn^l Tnlnabli', nnd no injtiiAoeptilile of coiidenaation or abndgmont, 
th«t we have deemed it boat to rrprodtic^^ tbo larj^er portion of 
it. " Tbv«i; prapcuvtiona," irn Mjm, " are cli-anly and vooiiomii-Al, Mid 
bave A much ^^reator diftattbilitj- or [H.-n(^tra(ing poner Ibau the 
old mercnrini ointinonU, fur thejr are absorbed by the iikiu witt 
romarkablo facility, and manifest the remedial effootn with 
promptitude." 

"Thai th«nlil D«C he nbbtd in Ilk* mi\»arj tinimctiU or nBhroMiSona^ hot ihowM 
b* mtrtif nf/i/MEt it»(4 a tii i *^, or if tpnad /ij^tJy fnr lA-t part w'lA mt /"jrrr .- 
aib«rau« Ihe; iiity mbn cbUomu iniutloii, or crtn pnduM • (•» p>ul«k« oti U>v 
«kio, ctpocUU; 111 onUtlo [wmMW. The rtinlt omj. bowftrer, b* obrlitud bf 
■dilition of a mikll ttakntiij of olira oil, *t ^luiAei Ikri, uwHing •> an oIiM(ii 
a> whIuoh pi*pu«liua l*r«qalr*d. Anjal t^we toRuaajbt iMiiM b^IWi 
of eacBti*! «!!•. 

''In «iiipIojin| tbtM msnatul wlallflu tw OMBkaliag r«mUlmt indanaaUM at 
ioiulM, 1 MNQ fooiHl (bat tba wUllIoD U marpUa wu ol wy (t«M advMlai*. Plv 
Uii* inrjca* lb* rinpl* atkalaiJ niut be umJ. aa neither the kydraeblwal*, the i 
f'MT lb* aMODtU, [a aolulito in oleic iclJ. for vnrj ilnuhn ol the Mlutiea of 
of uereaij la olele aeU, vat cnlo of uatfhit no; be xliUd. Ileloc, *■ ir«U m tb«' 
•amntj, «raijilrt*lj dteolrsd, it quite m npiJIf pcoetnio the ikio, vmn qalckly 
iaU MSlaM «itb Ui« •iltfmilin ut llo nfrrta, and ihn^ itn wiibla a few MlB«t«. 
Mle apes thno at tbeir iixnt >ru>lii>n polalf, uJ tp««dlly (eoduoa a aeoUilas effMl. 

Tlia o1fat« ol mui-urjr anil motphu. Uiiu iuiU«4 in MM iiTCTM^UiBn, repraMMU •■ 
■ ere, a liniuioDt, oiolment, or pJuttrel mmorj and apian; bat Ihcfar* far • 
alepal, MMMnM, and ■Oeacioiu^ A> a nle, aeconllnf to the ilw «( the pirt af k 
tma lea to lUit; inyt m mScieot lor oae application. Thit •hoaM bt itpeah 
(■kw dailf br fear «r tr* dap. Ihia U night onl; Air feoi or l>o Mber •l*j*, ami 
altonadl* vmj ether da; ualil • eate <* obUinfiL Tlie morphU inimnUalelj Unint 
!• lellev* pala, allap the •emaa initation, anil conM-|iWDt rienW torgtaoenee ; aiiil 
UiU* Binela iha pr e ( ieai or ' pirkileiire ' ut the InflaBiaalMj t «e«e>a ; wbUtt t)i« 
Aceeotj prebaMr pmteiM Ux daaU and depHraUcs of the »«rbi<l proJan*, and 



SlltltCl'BT. 



2G1 



fntUicalM thdr nibMqawit Ttmorftl b; •li«ariitiaii. I'nln* iiiifd 1& •w«inlira ((luiiilij, 
lb« utMtt of ntnurj dosi not taliralo, dt pTodoco nnj niitked MOtlitDtionBl duwrdcr." 

Mr. Har^ftU »tys "their applicnbility ftitd nlilitjr appear to mc 
to lio almost co-cstonsivu n-itji Uio ocourrenoe of 'peraiateut' or 
chrome itiflftmnudons, proTidod only that the scat of the disraso 
bo iu, or Boffieioiitly near to, the skin." 

'' I mix Bnt nuDtion th>t not onlj in p«rat(t«nt arlianliLr influnnmlian. but *'io in 
fitmpio t^norilU, th«M tomedie* npidly rvliott tb« WmlnniMa uii) pain, unci |>t(i<i.o<c 
tliv abMrpliOD of tb« fliii<l tffatcd into > joioU Ihtj sn> alw uF d(i>;iiliiil Iwiitini in the 
(hounutic, tb« irtbiitlo, and xi>* mtxad loriui ot Juinl diKsic : but in Ihi^ri tlirr iln 
oat, of coutHv 9Upi]raoJ« tbo QcCMiit} for gmeni tnatai«iiL In iDtlamniittiaD of Ibn 
nurnnur; uland, ooeotring durinji or «tUr ImUiIInIi tt altosntbcr iiidriwndvnlljr af (but 
Mcnling pinccu, their cffisncj ia luKiiolfoekl ; for t ha.n Hon, nat onlj tlig iDiluniiion 
igfl afti-r fiirTioaii ■iHCWuau uptwIQj iliuippoar uaJsr tholi uu, biit > ttndonrj to 
rMnrmil iiii|>|>urBtion In ibc illcol old iIsmboi, mil Ib< thtrotcnod tormntlon of n«w 
OBCiV ■ntlrei; oonttollcd ■□<! ftrntttd. I bitvu alaa Mon > lbT«ul«n«d al<K«« la tbe 
poriuMun from isSunnatian of ddo rf Oorptr'i gjMJtdi, >nd likewiio the tranlilMOiot 
iiiilcLr>tioiw lofl afUr erdinnr; pcriDoii] ahicaw^ rapid); ilinppcnr on the lue of iIicm 
pre[aiallon>. In obitlnate aini i>aln(ul t«aalllltli, lu eld<lld7niillt, in |x<rtD*lltli(, uid in 
i Hllauuunliaii «!tb imminflnt or aeluil nippDnUoD in or araand Ijuiphntio gland*, 1 
have limttarlf nnplojol tbnn vitb deoided a^lrantaicv. In bjdrwete th«f have not 
appMrvd to Iw OKtnl. I bun u>oJ e<\ual part* of tho '20 per Mni. oiatnirot and 
porllicd Inrl applicl oataide Ibo c^otid vitb ncccK, in bardcAlan, and la jalpcbnl 
toojuactiiiii*. 

"In man; cDloncotu affMliou tbo alc*t« of mcrouij tDl1ItiaD^ viilxiul uio'iibia, 
form «l#£uit und po«r«rfnl rvmediri. It was in a com of obitlnalii tftu>ii Ufnli llmt I 
fint iiMil, xnd vitb riMllrnt Kaulta, an otborlal toJuiion of tbo p«rdilarid« of toatcvrf 
miipJ vltli olclo acid : but I now miwb ynler, *■ tqWJjr <jHoae>ouiv ud foi Ink 
irrilAtiii;. ibf !i per ««nt. tolniion o( olvaU of luermir; in oliid bcdd, with tba aaldliiou 
cE an (iKbtli |<art ot vtbvr. (t)r. Aider Ssiitb ainplo;! a in prr cint. nolntion). Thia, 
■hen Bpptltd to tbo akiH vitb a ctmol-bair pondli u a nint dlffluonl and pooMratinit 
romcdjr. It ccton Ibo hair folliolm and the aebiMaaa gUndi, ponetrat** tlio bain 
th*nnl>t«, and carriM •v«tjvh(i* vlth It llj povwtitl nclatJIo onniitltuent. BwiJea 
ajvoabi. It ■111 cdfc cblouma and the varioiu form* of tiiua ; U ia tuofol in pniriEO, 
■ad in prantna an! at padondi ; but I hav* not louad tt Mrricoablo in noii-ipteido 
p«da>l^or In ocnma. Tbo tolutJon of olaatoul uoKurjdMtroja (wdiruli imive-llAtely t 
and, ovtng lo it* ainsiiliir power of pcrmoitioo, ■imultuicoDil; kill* tbe ora — a ntult 
not alinf* eMaio <tb«a oinUnenti oontaiaini; andinolivl inrrcur/ are nit<l. 

"A|ftln. la nanj of tbaao i^iibllliis affectiona (or tbe can of which mcrcnt; t* 
appli«abto, tbo oloal* of inerauiT prc|>anl!ani oOer loino adrantagti. I'bun, is 
toni^nilal (jphtljn, a piwo of the 3<l per ocnt. ointment, about the ilio of a pra or 
boan, placnl Sn the child'* niillir aiihi and nioming (jr Are or lix dnirr. rapidir aad 
taiiljr, an>l nitboul an; ai^n ot uacltanllnm, producca tacalilutionU vlTueu. Kvtn In 
tbg adult thia niodc of iaUodaeing mtireutj into iht ajnloni, oith«r for Ihe osro ot 
ajpbllli ft olbciT dianas, ina; ohm bo rrrfcrablo M, and Icn trotblraNiio than tbe 
halli, and It nrlalnly ^u lid ot tbe ot^Mliooa to tho ordiaarr mode of InoDotlon. At 
a lopinkl KDiodf for otrtaia looal manifeatationi of sn^iilu, mob aa tbe n on -nlei rated 
formt of ajphiJcdf raia, miieciallj «h«n tbaa* dUfi|uio the b»J, far>. nwk, or buidi 
tbo 10 per oenl. tolntioo I* a niott TiJuaUo adjaoot to other titniaital, tbe ipob 
npidlj dlulpp^a^iog atder lu DW. Thia, or tbo 20 per oont. preparation, diluted vltb 



SW2 



HBBCUBT. 



ciiual [i«rU dI porldcd lai^l, mar •]*!) be •pt''°J (^ noa-ntotf«lad i^plulitio iadoiUiona 
and ooDilitoiDiita. trnl it eiin pain if uppliiil Id tuifaoM muofa •leoriiteil di ale«Iit*d, 
la mDUi wu-tK, |jr tn uiucoua mtmlmuiw. Id tf |Jillttle iiltU, an-l >[>i> in noa-aptellia 
fanna of that iIimuc, lib dilated «lnM oicimciit imuuxil orn, not witbis, tfaa C7«lid. 
fiditnXij iirnmotfli tt« abMrptiOD «f tlie tdaned 1; mpli. hullj. In leino of tlm rrmotcc 
lilndi of ijiibililie &S»«ltonit, vlileb loJtdn ul (ulaiiiiiiui vlLI onuill; cnri', nch m TvT;f 
bird sodoi and cciUin lorau of ijphiliiio tntulo, tbc citanul appliealioa of lii« cleala 
of menurj it rorj TaloaMc. I hit>« Ken a omo of tnliUEfl Icstido tpididfnil*, tb* 
Kjliliililli: origin of niilcb hod not btan HtwiMctcd, and (or ■blolk na mcrcDtlal tonne lilAI 
b«a prcvribcd, bnl vhich, dDring a po-iod of ni foan liad bcoo. (ram tiiu« l« tim^ < 
irliCTSrl li> onoTinoitK do*ea of iodide of jnttaiMiim. tpcediiy and <l«dctedJj bMvSUd bj' 
tb* luandioo of Ibo SO perotBt, jntircBrial oUal*. 

" In i«f(Rii<i! lo otlicr Dwa of tbo BomUned oliaUa ot m«ttin7 tad mttpbu, I nkj 
muarii that I nnnol d^■abt IliMi niloe in tb« tnatncnl at 'penialiwt' inflammatiOB 
of ecrlain islarnal parla and organ*— M, fnr tun>i'1«, «( obclloat* ploitrijf, pntuniaiti*, 
L jwriganlitii, ami endoncdilii ; tat Xhej wouIJ iici* a!*o alia; |alii and iierroiu iitlUtLta ; ^ 
[vouU Iliua vDutribiitf tn*atdt tbe umt of prot"^TP diicur, asJ wooM Hkawin 
pramotc tbo ptooua of abaorplion. Mortoiar, I tnnj lUU Ibat a Nlution o( morphia In 
oliio aoid (oDt or two grain* to tbe dtaobm wllbotit mtrcurj), li an cmllent Ifliilcal 
rontd; to Donralgia. aad in ibal (iqui>ll«ly panful aS«>-tioD, heipta ntln', oan l>ei*c 
Uktn not to |>n>duee cuUDtnui Irritation hj friolion, 1 ha** alao uaod, vndomloallf, 
vUb adTMUca^ a wlution of atropia is oUin n«<l, tod bars bad prepand for me tbo 
oImIM at tine and cojqitT. bob of Ibtaa prrparalioni wilt pipb^iljr tunic to haire its 
wo, to wblcb. boaeicr, I bti* now oulf llm* tbna |«norall]r lo nitt. Olrio aoU iqj 
likcwuo a i«adj iolrent of canlbaridino aod croton oil. U ii ilacK apcritml, aoAj 
[KtsaalM bt9«* nor* nadil; than olW* oil. lodtw!, I (iillf nntitljat* that tbit aoid,* 
M ««U H lu wapouoda with Batcoi; and wltb morpbla, boiilci otiut propatitlona ' 
naJ* bj ill aid, vill ertntaaDj be ajimittcd into tb« rbartnatopn^ An ointmoDl of 
Ui« oltalo c( nirtenry wonid almoil inpcncxJe Ihc u1<l'ti»hiiii]i.it hluo oiniment. vbilat 
tbt loIiiliMii uf Ibe oltala might rtplaet lb* linliin'iit o( mcRotj. Tbe rcmainiaCi 
io«nnrial oinltuenla of Ibo PbannaCDparla, a( nliicb tli« nilrata maj contain a lilU*J 
elMla or aam* alU*d **!>, «ill, boaerer, ■till ban tbnir iptcial n***. 

"Tbeokak niMt bo prFjiarod vltb tbv oxide ]in«ipiMted bjr otwtid potaih ar aodik j 
Itvtt • aolnUan of tbe uoul in nibio aiid rMtotljr nailc anJ veil driod. Tb« ••Inllo** 
ef niMrearjp bjr olt>(« aeiil iianiitfd bja toai-traluicol iOO' Pali. 

"H* 9 pir cent, •olnlion 1* a |i«tfMII; dear, |«le jollo* liqtiid, mcmtilin); oltra oil. 
bni tliloaer ; tbt 10 pti mat. MlutUn 1* alao fluid and p«r(«otlj tirar, bai aa dark aa 
Un*Md oil ; «hiUl tW 90 per ctnk pnjwalinn u as opaqo*, jtltowiab. anoluou 
aataUoo*, cIukIj nMnhlini in appeannte mis oinioienl, meltlac T0t7 rtadtly at lh« 
temperalun of tbo U4f, and fotsilnc a kind of Uaaiisrect, tiMid, ootonrioi nuolth i 
«btt aptitiert to Uie aUu. Tbe eblaf care la be oUnn.>d ia tbe lotaufaMarc tt tbo* ' 
mInIImu la not to bwrj the prtet**, and not (o naploy ■ hlcb l*np(t«tBr«v " tbn 
ntKnrr «iQ b* inmcdlaUlr ndoctd." 



Oallia of corrowiTD subltmato nitd chloridQ of uainoninm, tn tbo 
proportion of bklf tta onnca of Knblinurto lo o<i« onncv of lbs 
oblonilo,Br«MMnotimMiiMfiil tn tho tri-*(mratof obaliiuilctifplinilio 
and Ban^TiihtlEtfo ruboau 

All oinlRtonL of binioditU) nf iitcmQry htm Ikvii Iiirf;fljr iiiii{ilii^'c*d 
in Inilut urtth ronutrkatili- ancvuM in Uto t.n«UiM-iit of gottn. I1ia 
setioa tif tlio oialmi-iit is aidod by lbs eSecto of tbo nun** nyt, lo 



MKSCUKV. 



263 



whioh Uio tomonr is ezpoBcd after iiianction. Tho ointnivnl in 
prepared in tlia toUowiuf; way :— Molt three jKiunOn o( lard or 
mniton tcnot, stmin, and cloan; wbcn ni-uHj^ coul, add iudq dntchaui 
of bitiiudide uf tuetcuiy, Gnelj- trittimU-d ; work llic mixture well in 
» mortar till no pivns of rod arc visililo, and koop it in pats, pro- 
toctod Crum tlio liglit. In India thi» ointment m applied lo tJt« 
swelling at eniii-i«o by m«ans of an ivoiy epntnla, luicl is tbon vntll 
ruLlied in foratleiiat li^ii nimut«H. 

Tho pntiont tb«B site vritb cbe goitro hold up to the won as long 
as ha can endara it. In Btx or ei)flit Iioum tbero will ytrobablj be 
■omo pain from the blistorinn; action of tho application, allliough no 
postolea will Itavo amoiu At about two o'oloolc in the aftei-iioou 
a Mcond application is made, the ointiiKmt being mbbod in with n 
liglit hand ; tliu oiiitmunt in then attuwed to remain, and Ila abaurp- 
tion is completed about the third day. In onlinnry c«»m one encb 
ooumo curcM tho jiutiont, but iu bad ouvs it may bo neoiMHary 1<> 
repeat the treatiii«nt in eiz or twolw ntontlM. In coantriM where 
tb« son in I«m [xiwt-rful, tho jmlient !tit« beforu a Aeroe fire: or the 
ointment may bo robbed over tho Kwolling night and morning, 
afterwards cowring it witli oil-skin. The full aftixt iti ]>rodueed in 
a few days, when a mild ointment like spn-macoti ia subBtitatnl. 
(Stainthorpe.) 

Mercurial ointments are usefnl in erjtbeoDataiis Inpim (Moris 
Kohn). I havo aeon groat advantage remit from tho om of oalonyil 
ointment or black-wash in sorofnloaa and tubercolar lupas of 
children, and in open scrofnIaaN sorea. 

In taberonlar lopos Kayler advises tonching the snmmil of the 
taborcloo with tho solution of acid nitrnlo of mcrccrj-, repeating tho 
af^catiun till iluiy are reduced to the lerel of the skin, but not 
d(<eper, or a ecar will rosnlt. Each application vxcit«« a i;oo(l dvid 
of inflammation and pain ; hat the pain may be allayed by covering 
tfaa spot with collodioD. Nayler uses tho mercnrial vapour bath in 
general ucwtma. 

Mercurial prepEirations, ospocially black.Hash. are very nsefnl 
applications to ityphilitic sons. Thna muoous lubcrelts soon yield 
to black-waidi. Ulack-wash ia ussfnl, too, for those elevated indu- 
rations ovauTriiig at tho anus of oltildrvii, dilfvring from mucoss 
tubercles, being of mnoh larger sixe, of irrvgalar shape, often limited 
to one side, and gwuindly cxtiiuling some way np tbo reclnm. 
This oroption, which may bleed and BDMii aereiely each Ume a 
motion paeeea, often disappears but slowly nndor tho inllctonco of 
mercuiy administered by the montJt, and nisy. iu spite of it. coti- 
ttnae inoieasing slightly for months; while, if kept oonstanlly 
moist with Uaok-wasb, its ivmovut may bo asirared in ten days 



•iAi 

or a fortnight. Bbck.wach ia very ascfal in other »f|ihiiitiB 



Wlian It ii not oonrcnicnt to ippljr Uoeb-wuli, calomd or dlMlW 
ontatMit well rubbed in luaj' \» aDbstitoted. 

Cftloraeli diutod orcr sjr|>hil)tic ooodflonuta, gcncnilj removM 
thesL 

CytaaAA of noKurj in Kolntioa, in tbe pioportiaB of ten or fifcom 
gniua to an oanoe uf water, ia useful as a local application to 
Nflihilitu: nufata and aoroi, na tboao of tiio throat, tongus, aniw, 
pcniB, <iCc. for BorM on tbe prspoee orf^aBS, a weaker aolutioo af 
tivv gniuM lo the ounce is gonetally strong enongh, and ovm thia 
MtreugUi soiaelimea exdtea a good deal of nnarting. It shootd be 
vr«ll nibbod in wiih a catad-bair bmeli, once, or at moat (wioo a 
daf, carefnllj avutding the neighbouring healthy tbauee. In oaae 
of obaBcrea, it is a good plan (o appljr this totion daily, nnd to k(W|) 
the aone moivt iriUi lint soaked In black'Wasb. Ifercurial ointments 
rubbe<l into tho i>kin of tlie penis am often apt to bring oat a crop 
of eczema, with oontiidenble awirlling. 

Mi-rcarial npplicationii mixed witli other snbstances, as tar, ato 
rcrr useful in sjphililic psoriasis. 

Ur. Leo strongly recommends mercurial fiimigat*oiu in the treat- 
ment of Kypbilis, preferring calaroel. which is nndestruj'ed by bott 
or moiiitarv. and gives conKtant rceulta. Some emplny dry fnmi- 
gution ; others maintain thnl tlw therapeutic effeela of mercury are 
inoTonaed by stvam. This mode of ndministeriug mercnry is con- 
sidered the best and sarMtwayof endioatingtTpbilia. Aiorwvcr, 
It affoola tbe gonond boaltli 1mm delotcrionsly, distarhing neitlur tlio 
function of llie Klomuoh iior tbn int«tin«s. Ten to twenty gmtns 
ol calomel are uim.i1 itt each famigntioD. Tbe fumigationa euinirtinioa 
invdnoo a good deal of wuukncsa and prDstmtlon, so Uial tbry cannot 
tw cotitinnod, Tbore can be no doubt that many ooses of Hvphilis, 
relwlliou* u> nthor IroAtincnt, ylsid to these fnmigationiu tiomctiiiies 
only a portion of the body alTocted with sjriihilittc nsb is sulqeetail 
tocatocnel fnmigstion. 

Uorcurial applications, bnt esiwciaJly the aoronml and calomel 
oihlmitutm am rubbed into dulicate part* of tba akin, so as to m«r- 
fiiriiiliKi' the system by their nl)aor|)tiou. This tnetJiod lias tlio 
luimnlago of nut iliHonlering the digimtivu canal. 

Biuhloride of merciiry bus bora injected under tbe skin, and k 
Dinob smaller qmioUty affeota the systom than when wlmioistcml 
by tlw month ; but iJiia painful mode of Ireattng syphilis is not 
likely to booon* gcnoml. 

At one lime Ibo applifulion to the faeo of mercurial ointment 
or of mercnrbtl plnoter was iu vogne lo prvvvnt the |iiltipg of 



lUtCVKt. 



2C6 



I 



Eaaftll-pox. It IB a qncstiou of intcrcat, whether tlio mercury iteolf 
pinyit iiti}' pni't in nrruntiiig tho mntumtion of the puHtulcM, <ir' 
whether other spplicntiona iiru uot aa elTwtivo. A ^txi de&l has 
bueo mid on cnvh tide of the question, but i think that, sinca 
BCrend instoncen of very Hcv«rci unlivntiou have followed this 
plaetering in emnll-pox, other safer remedies tnnjr bo UHi-d, ixThnpH 
Dot with (iqtutl iwnefit, y«t with mfficicntly t^oil reaulte to render 
it deeirahle to employ Ihom in profcTenco to the morcnriid coin- 
ponnda. 

The exclnaion of light and air ptobabij- thwarts tbo dcrelopmi-nt 
of the pnatulvs and prcvontA pitting. Tbo t-xclaiuon of nir and 
light can bo perfectly effuotod hy collodion and iitdia-mbljer dis- 
Molved in chloroform ; thin, or other means, ahonld therefore he 
employed in prefereooe to mercury compottnd& {ViJe Nitnt« of 
Silver.) 

In noB.eyphi1itio ozcsda Troiuiefta employs tlie foUowing snaff. 
pon-dura: — Wliito prccipitetfl. 4 gnins, migAr in fine powder. 232 
grains ; or red preciintate, 4 gruoa, sngar in line [wwder, 'ii2 
gminn. Thi! none is firvt cleared by blowing it strongly, and then 
K pinch of eitlier powder ia MmfFed up a few timui daily for a few 
days. They <|u{ckly remora the stench, and modify the atato of 
the mucoaa membrane, though aometimca tUey prodnce a rather 
imwerfnl irritating effect on the mucous membrane, and, unfor- 
tnnately, they do not c-uro tliis very intmctahle complaint. 

In the syphilitic oxcvna of children, mercurial nintmonto, a« nitmtu 
of merotu-y ointment, partially molted, applied twice a day after tlie 
no«e has been well cleared, will arrest tho eocrotion, remove the 
obHtruelion, and improve the condition of the mucouH membrane; 
the child's health itnpraves, for the natal obetraction proventa kucIc* 
ing, during which the child is nnnhlo to breathe. It is well known 
that a child, oepeeiolly in Bkeji, breathes only thraagb tho nose ; 
conaeqaentty the henllh mnjit snfTcr thmngh inability to sleep when 
thu naital parages are blacked. 

Mercurial medieincst, if administered an nndne lime, ecveraly 
injure tho mncoas membrane of the moutb and nlivary glands. 
I1ie linrt symptom is a dimgreeablo metallic taste ; tho frums arcmnd 
iho teeth become swollen and tvnilcr.of adark-ted colour, the mncoas 
membrane inveMing the incisor teeth being the first affected, whenco 
the inRammatioa spreads ; the tongue swcltx, tlie breath ia exoeesirely 
ffttid, the searetJon fnm the buccal mucons membrane is nagmentcd, 
and the ealiva ia inorcaacd inqiiantil}- ercmtothooxtcutof oueor two 
|HntB daily. At first '.he saliva is richer than uatnial in vpithelium 
and solid oonMtitacnliE, but nftvr a time becoOu's ciciii'er, more watery, 
and oont^na fat and mucous corpuscles. The iwlivRry glands be* 



aoo ^r^^r M8BC1TBV. ^^^^^^^m^^m 

oome BwoU<!U and painful ; ai liknt Uio inflaninuition of tli« moutli 
mobw BNcfa a point that ukontion aota in, and profjreeses till liurgo 
]>ortiona of the goniH aiul chooks nuty bo destroj'ad, tko t«etli becom* 
ing looeo, «nd 11m bonos of the jaw carious. Somo ore mncli mora 
prune to become italivatod than othora ; weak p«nonfl ftre more otwily 
tUToclod titan Btrufif;; children are rarely salivated. Uiwow. too, 
inllaencea tbo operation of mercnr)'; for in inilainipatioji it is oftvn 
xrall borne, white in gninntnr iliHoao of Ihe kidneyH or in surofula, 
pativnUt iiri! xevy liablo to bocomo eBltvnlod. It is Htatcd thai mlivik- 
tion haa ocoomsd throe hours after a dose of morcncy, lliat it may 
last » fow boon only, or ondnro for bdtktaI years, and evon di»upp<»r 
foT a timo and then return. 

Thsn ar« pcnuns who can noror tAtco oven il Hnudl do«e of metcnry 
witbont proTokin^ toothache, f^-nerally in a carious tootb. 

In a cortiun stage of tonitiUitie tho inSnenoo of mercury it most 
marked, owin^ )iro1mUy to ita absorption in the circulation. In 
qniniy or Kcarlatiim, wUon the unlarged totwiU almoiit meet and block 
tlie puaa^ and when the dilBouliy iti KWnllautn;; is nearly iusnjtrr- 
nble, with eron dang«rof soffocatioo, at enuh a crUi* a thml nf » 
grain of grey powder t»ken every faouri greatly redncoa the awoUiii)^ 
in a few bnnrg, and obriatoa the distreas and dai^r ; and, even if uui 
ab aw a baa fomud, ita matnrution and evaeuation appear to bo 
(^ITectod mora ({nickiy. 

I'hfl same powtler, administered in the Mtmo doas three or four 
timea daily, in nacfnl in mnmpa, speedily relieving tbo swelling and 
pain. Probably, aa in the laiit eiuo, tbo drug acta only kftor il« 
abaorption. 

The aolable |>ivf<inttinni> of meroniy oombino with tho albuminotis 
mat4ora in tlw mouth, and any portion left nncombincd attacks tll^ 
ntnootiB HMmbrnnu, and may incite in it aonto inflammation. fl 

Tboy net in a Btniilar manner in tbu etomach. 

A fomi of voniiting in iiometim(v met with in rory young ehildrva 
— genemlly only a fow nocks old — which yields in many ioatauco* to 
grvy pow<Ier or calomel, but especially to grey powder. Tho chief, and 
to a gnnt coctont cliamotoristic featnro of this vomiting is )t« sudtlon- 
noss and iiutitntanuoiixnnitH, for immiilintely tba luilk ih gwnlliiwcil it 
ia forcibly expvlloil. ctmllL-d or nuimnlled, appftrcotly without any 
rctvhing or elTort on the part of tbu child. Tbe milk lilomlly sluwts 
(Mil of bolli ntouth and noae. Uiarrlimn may exist, but mom genemllf 
tlxm ia oooatijntian. Ilii* afleolion often proros bolb olwtinnlo and 
tlaagoroaa. as oil the food ia ejected, till the child, rvdunxl almual to % 
skeleton, dies lutualty of starvation. At tho pMl uit>r(«M it oftian 
happoDK, Mther that notUa^ ia fonod to acoounl for death, or tho 
muoona luanibrana UMy bo mncU softened, anl liko wnlvr arrowroot Ux 



XESCtKY- 



267 



conHiKtoncT ftod ap)>Muitnoo. One-third of a f^ain of pmy powder, 
repeated ovory two or three lionrs, will in tanny inKtancon quickly 
iftuj this vomiting. wliicU rciiists all oilier reniivdif^ A twelfth of lb 
grain of calomel 8J§o ovoiy two hdiirn Homtrtimos siicceods. 

Tho Koltiblfi prrjmnitiuuii u^-t an [lurgntivvH, iiuircosiiig ihe seoretioo 
from the mncoua linint; and tho contractions of tbo niaecalar oont of 
tho iDto«tiDG«. Not all. howevor, are omployeil an parfpttives; and 
when pnr^tioQ lb needed, our choice falls cither on caloinol or 
grvy jiuwdcr; either, being la«teleiui, ia a uiidftil prcjiaratiou for 
childreD. 

Moot pnrgatiruK act room clBcicntljr when givt-n in fruqnent Minall 
dowe, at every hour; bnt this does not hold wiUi calomel- Moreover, 
according to my experience, w(' do not mnch inoroara tho purgatiro 
effect by auKinenling the sita of a done, a grun acting aa enorgeti- 
coUy H flvo grains. Again, whonr a nightly purgative im needed, 
calomel doea not answer, for tho doiio adequate to produce foor or 
Gvo Qintions tho Brat night, will act only twice or three tirocH tho 
second, and often not at all the tiiird. 

Tho infioence of mercnry Hilts on the ]ULncreatio and biliary 
■eoretion is still ondocided. Seeing tho inflnenca of morcniy on the 
salivaiy glands, some conceive it proL&ble that it exerta a similar 
inflnence on tlie paiicrnui, a gland with a (rtmolnro and B RCnretion 
very similiar to those of the salivary ^'lands. 

Most opposite sttttemcnts have been made oonoeming tho action of 
mercury on the secretion of bile. ¥tojo esperimenU on animals it 
haa Itcen concluded, though not without dissonticnts, that morcnry 
in health diminisfaea the aecretion of bile. In bis report, as soore- 
tory of tho I-^uinbar^h eoinmittco appointed to investigate this 
mattin-, tlie latv Dr. Hughes Bennett arrived at somowliat tlie same 
conclusion. This report st&tes : (1) That neither blae pill, calomel, 
nor corrosiva snblimato, nffcot the bile nnless they pnrge or impair 
the hesdth, when the qtiaulity of bilo is diminisbml. (-) That 
during an attack of dysontory, l>oth tlie mlid and tinid constituents 
of tho bilo are diminished. (^) Porgation fron any oauso lessens 
tbo amount of bilo and tho pi-o|>()>rtion of its solid oonstitnenta. 
(Soo PoJopkt/lliim.) 

RShrig and Rnthorford have ro-invesligatod this snbj<K:t, and tliey 
conclude that calomel does not increase tlie secretion of bile, nay, 
in purgative do^cH, it may even decrease it. Itntherford Ends that 
bichloride of mcrourj' does inonnae the ■eoretion of bile- 

Dr. H. SutDdt'i wtnnn'tlav niwriTiicnUi] an tlDp rtfokil; id. Itnlberfoitl miJ 
RMrii:. 00 futing dog*, tn ervr? liitUn^ flnit luimljfiinG thf nniaiiil n^Ui curare. 
Tti«3r fint iaKit«4 » gIsM eaanoU ialo lb; fraamon bil« ilact om lu 3iinoiioa ■i>h ib« 
duodrnum ; tlita wwprw wl lb« pill hlo'liUr tn 6\\ tbc tube •iUi bilcw tnd olunptd tbo 



268 



HBKOITKT. 



IIdi>«i1 llinocli lb« meduIb- 

1d Mint tipsrinviiU Ltutliorford ptkcol Ui* eaJomel in ti« ilaodemiTD onaliad wllh 
bU«, in otlicn miiol vith U : kad id oUion be adminutered th* otlwnel tpy Ihft 
■lomMh. 

Y«t tlip mperienco of generations otrunj^tjF impportit the i^enetml 
oonvictioii thtX in some diwues oolome], as wdl aa olber prciMm- 
tioitK of morcniy, does tncreuo the Irilo- Moreover it in not difficult 
to conooive tbat in a (riven diwEsse nercuTT maj- set neido some 
condition hindering tlio formation of bile, and Uidh not an a chola- 
gOKXte, tliouKli posHilily in Iiealtlt it m&j even check this eecralion. 

When given to promote the secretion of bile, the common |>nK!tioo 
IB to i^To a pur^tiru doiu for one or two uij^htci ; fant if there is nu 
coniitipation there is no need to pnrge, and a small do«c, my oao- 
sixth to one-half groin of grey powdKr twice or three times a day, 
will answer hotter. The adminislmtioD of small doses frciucntly 10 
Mptoially advantageous in cases where the illncM in apt to ivcur fro- 
(jncntlf from sli(>ht and scarc«Ijr preTeDtibleoauHes, and whore tho 
beqaent cinployiuent uf porgativo doMS vonid favour aftor-«wn- 
stipation sod prodnoe depresstoa and posubly salivation. For these 
roeaons it i* common to hoar highljr practical doolors decry more a rial 
preparations, wberoM irare tliev to employ tlie iiuuut« doeee now 
recommended thvy would o1>tnin the deeirwd olTeot and oxclado the 
bad lesnlta ihey fear. Oivcu in the doeea just mentioned, mercurial 
preparations in certain cases which I will indicate are signallj nee- 

'I. A [mlienl voids pale clayey stools and saflcn from nciditj, 
flntulenoo, or vomiting, oocnrring eoinettmoe only before breakfiMt. 
Half a grain of grey powder given three times n day will often 
ratora colour to the stools, when the dyHpoj>t)c symptoma oeaao at 
once. 

II. SmiUl doses of mercnry yield excellent results in a form of 
diarrhoa common in children. Tho child's liiralth is hid ; tlio 
diffVNtion is im)Mrfuat, generally with annoying Uutulciit dit>ten«iun ; 
aud three or four pale, clayey, pasly, stin'ting motions aiu passed in 
the day. A single grain of biehloriilo diwolvcd in linlf a pint of 
water, ukI a teaspoonful of this solo t ion given each hotirior, Still 
better, oDo-lhird of ngrainol gniy powderovery l«iur or two hour*, 
will in one or two days limit the iiuuit>er of the nIooU, and rostoiv 
tbnir nalnral liiltoos colour, even though Ihvy have been olay- 
colnutT<l for weeks. 

III. Again, we froqaently meet with a case lilcu this: — A patient, 
genemlty nf nervous InnjMttnuidtit, on axpomire la cold, or aftar 
Attigna or euiitementi or even withoot any diaDorunUo oautOi feeb 



f 



UBBCOBT. 



S6d 



It 



h 



^Ic, perhaps vomita, hM ft coftted ton^e, ftod in a few honn bft. 
comes janndioed, tho (liscfllomtion somotimcB nlHecting: only tho 
conjunctiva, in oilier coacH dyoing the nVin of the whole body yellow. 
The stooU arc jinJo or colonrlcBS. The ntlitc): la»t« three or fonr 
ibiys, and is accoiupaaied by greftt depression. The patient may 
DndergD nnny itttAclcM, im frequently indcud, thai befDre the dis- 
coloration of one attack has passed away, another has begun to uaail 
him. Here ono-nixth or one-third of a gmin of grey [Kiwder, Inlcen 
at the very onset and repeated three or four timoB a day, allays 
the tHokaem, cat« nbort Ibe illnrss, inoreoutLii the intorrol.i between 
the atta<tks, and after a time cores the patient, though ho may bftro 
soffored thnu for several yearn. If, however, thcru ix obstiante 
constipation, a course of Carlsbad waters is then sometimoa more 
efficfloiotix. 

IV. Tho same weak bichloride of mercury solution of h single 
grain in ten ouneuii of water in da«eK of ft towpoonfnl. is very 
cAcieDt in another serious form of diarrhon, coTnmoD in children. 
Tlte chameteristies of this form are rery idiiny itoDla, eB]»<;i(U)r 
if inized with blood, accompanied by pain nnd straining. The 
Hulicnt indication for employing the bichloride is the iilimy obaraoler 
of tho motions. Sometimes the alimo is very tenacious, and, being 
oolonrod with falood, in dcirribed by the mother as " Inmps of flesh." 
This affection may lie ncate, or it may lie chronic and last (or months ; 
but in either cssse the iMchlorido euros with r(rmiirkabloKp<.-ed and 
certainty. 

V. A similnr tnMtment K^Hoves thi- dysenterj-, ocntv or chronic, "f 
adults, providi'd the stools nre slimy and bloody. A hundredth of a 
gndn of tho bichloride given hourly, or every two hours, according 
to the severity of the cnse, is gonomlly loESctont, mroly failing to 
free the stools from blood und slime, ftlthongh in some coses a diar- 
rbiea of a different character may continue for ft short time longer, 
rotjniring perhaps other treulmcnt to control it. 

VI. A sixUi of a grain of groy powder given hourly Is of great 
serrico in infantile i-hokni, chnraateriKed by ineedsant slckucu, with 
profuse and almost continnous diarrhota, very offonxivn and copious 
motions, watetj, almost cvlourlcws, or of a dirty muddy ns)>ect. 
Under this traatm«nt Uio vomiting gonetuUy soon ccaseii, and the 
(Linrrhoen sltortly aflem-arda. Infantile vholem is an extremely fatal 
discMB. running so rapid a ooono that in a very brief space a child 
is rednoed lo a death-like aspeot and dangerous condition. It is 
essential then to chock the diarrhtpA a« speedily as possible. In 
urgent cAHTs a starch iujcclion. with a minnte qnontitj of laudanum, 
aaiisls tho action of grey powder. 

VI I. We often see in intents a cbroDtc diarrfatea, cbaincierixod by 



270 



HBitCOBT. 



wMaryi vary offtoaTO, nmddy-toolnng, or grovn-ecdoand vtools, oft«n 
to th* BitBilMr of ten or twolvc dnily. Tliia diarrtuaa will (pjaeimllj 
jivtd to grej* powder, in doeca of ft sixth of a grun, givon ftt tirat 
hourly, and Ihun over}' two or (bno houra, according U) the fre- 
qa«ni:/ of the stools. Vomitin^f is an »dil)tioniU indicnticm for tbis 
tnatment. AUboagU thU itrag mnj chcok the diarrhow and voraJt> 
in)!', 7^> '' ^'^'^ disease liaa eudunml n long timo, so norionx may ho tha 
injni'j infli<^t«d on thti mncous rocnibninu of ih^ stoiuftcli, tb&t food 
Oftu neilliur l>e diluted nor absorbed, and tbc cbild gntdoally M-aKl«« 
awftf. The appearnnce of tbrush in tbo moiitb is an nDfaTountble 
aign, aa it f^inarnU}- indicatea profound dama^ to tbo iuu<!onK innD> 
bmno of the digostive cftnnl. So also it is a bad ai^ alwrnys in the 
chronio diarrlio-'u of cbtldrvn, when the aiools cbongo in obaracUvr 
&om IJmo to tiate—now watery, then slimy, nl another time curdy, 
and at another green. It in far cnxiiT to oiu« a diairbcoa wlwn the 
motions are always of a nniform cliaractor. 

It i» important to treat the Hi>v<rn! fonrnt of infantile dinrrbcm 
promptly, for being gtmi^mlly inflammatory-, tlio mncous mombrttnn 
of the Inr^'e, and even thai of the small intestine. Boon beoomM 
seriously alTocttid, the mncona membmne of Iho Urg« intoatjno ex- 
t4!nMively ulcerated or considentbly tbickmed and granular-looldni;, 
whilst the mucous inombrane of Ibe small int«et)no, a part of tli« 
tnbc less commonly aScctod, may be mufib softened. U will Im 
itttdily nndonrtood that disease so extensive mnst take somo tim« to 
cure. 

Herrnry, as we havs seen, prove* Tvry eervioeabte ia moct of tbe 
forms of infantile diarrhaM, both noate and cbrouui. I bare on* 
de*vonrad tn point oat catefpmoally the circnmstancM wlien nita 
OMircnria] preparation is prpfomblo to anotbi'r. It may bo urged 
that, ns in both sovore acutf and I'bronic diarrhaw ihn samo |iatko< 
Ingioal conditions an> Tonnd, that tbir Knmn fonn of mercury siiitabla 
fur one case wonld oqnally Iwnefil anotlivr. But, tbongh the jMitho- 
logicBl state is ketd to Iw identical, still aomo hitherto nndutcoted 
dlfferencca tboro most be, either in the nalnro of ibo disease ilsalf, 
(rrof the ]Hurt it alTucts; for saroly it tv<)uima diSt-nint pathologicsl 
voiidilion to prodnce in one catHi iilitiiy stools, in another wut<'nr, nnd 
in anothoT ^nen iiinly stool*. These differences displayed in ilio 
oymptomSi tbongh at prenont not disoriminatod pathologically, raqnlre 
■omewhAt diflerant treatment. Hcmw, tbongh tn each kind of di&r> 
rfaon all forms of mercnrr are usefnl. it is foond that in eonin luuma 
bichlorido of Diorciiry is greatly to Iw profentil, and in other caMa 
gny powder. In lliu tntatmonl of obronM^ diarrhooa, mercoria] 
l>ntparaiions nnt oft<m rviiuiri-H for many days, nnd it fr(x|0«nlly 
hftppaos thai, lltough Ihey niter the chaiacter and loaaun tha frvqneuey 



HHROITBT. 



2?! 



I 



of ihit motions, yet the diarrhoea may pcwist, and may roqniro for its 
ours otlior rcnictlips, Itlco lime-, umcnic, and nnx vomion. lu tbe 
trcntmcnt of c-)in>tu<s aa well as in tbat of acute (linrrhcpa, too tnnch 
attention cannot ho paid both to the (]onJity nnit quantity of tbo 
food. Acnto diarrlicea ta oticn i^gravated, and made chronic, by 
crar-feedin^; a short timo nitrr each meal thu child in violently 
pnrgedf imcl tlw motber aeeinff it waaticif; r&pidlj is apt to think abe 
can anatain ber child by giving ns much food m pomibln, Iral it mnHt 
bo borne in mind that di^-eiitiou is Kif^'^f impturedi so that but little 
Ibod is digested ; th« oiuwit, lodfpng in the int«iitinal canal, nodor* 
gOTM ilcoompoeition. and, actinf; as an irritant, iorivasoe the diae«ae. 
Not only shotild thu qiiftntity of food bo nnall, bat it shonld bo 
gi\-cn frequently in very small jiortions. It is also imitortant to 
cloth« tbe child warmly, and to put a Htuinct roller round the belly. 

Tbero i^ n form of diftrrhoea, iu which tbe child pasKS large, acicl. 
oReDSivc, curdy stools, oridontly consisting of decompoRtng cnrds. 
Mnrcnrial preparations, and, indeed, tbe otlier nsnal remedies for 
diarrh<Ba are of little avail in this form of diarrhait. whicli is U-Ht 
ti«at«d by witholdiiig milk entirely and aubslitnting animal food. 

The chronic diarrhcra of adults, indopondont of Mnrions cfgftnic 
change of tho intestinos, with watei^ pale stools, often yields to the 
hnndredtb of a gmin of corroxive mblimato every two or Ihroo 
honrs. The sane treatmeDt answers sometimes in the diarrhcea of 
typhoid foTcr and phthisis. 

With onc-tliird of a f^ntn of grey powder thiee or four timc« a 
day, a thickly-coated creamy tonf^ne oocurrin;* in dyspepsia, in thn 
eonriici of chronic dincniH-, or in early onmmcnccmcnt of conralcs- 
(wDce from an acnto illness, will genecally ni])tdly {tet clean, with 
KJmnltaneouH improvement of tlie n])pctito tind digcittion, and removal 
of disagreeablo taste in tho month. If there is constipation then it 
is iHittcr to give half a f^in of calomel with thme gruns of extract 
of liyoBcyamns repeated for throe ni|;hts. Tbe first pill gonerally 
jior^s twice or thrice, the second Icos, and the third not at all. Grey 
powder sbonid bo given if there ia either dian-hcoa or tendency to it, 
for, bcmdes itj effect un tho tongue and stomach, it will generally 
control the diarrii<m, at the same time restoring their natural oolonr 
to the motion*. If too light or ton dark. 

With tho exception of the sulphide, all mercury oomponnds enter 
tiu: blood, and are emplojrnd in a variaty of disesMa on aoconnt of 
tlicir action on distant organs. 

Lipgcoi-i (lia:. rfw Bop, IStitf) states that small dnscs of corroiiTe 
snblimate increase the weight of healthy men and animals. Recora 
and Gmuii wty that mercnry diminisbos the red corpmtclea. Ou the 
other hand, Wilboachewitche (Arehita de Phyt. 1874) fonnd bluit in 



272 



MEHCDHT. 



recent a^IiUiit iiinAll tlosoe nf mematj at firet incranee the nnmbor of 
red ooiposclefl and e%htly diroinUli tht> whitct, and thnt if the in«r- 
ciity M cuntinni'd bojrond a cortAin point, it then Ii^ssens tbo red oor- 
pBBclm,an indication to diaoonbinae the druK- Dr. Kttvvti (Avterican 
/iwnud f'/tho Mrtiical HfUm^!», Jan. 1876) points ont that the doeen 
given hy Wilboochcwitclifi wero bj no mMua mniill. Dr. K«jro> hxa 
himKclf tlinronghly and phi)o§ophicalljr tnToetigatod this sabjcct, and 
I subjoin the concluHionM he arriveaat: — 

I. TtiBt 6,000,000 red blai>d.«i»pi>ulea in ih« iratiif m.ir, ii in avenge for bealth)! 
ailatf man. In umnis tb* namber nt*\] UIU btlo* !t.(iO(l/)00. la fiat conditioaa 
ef ph^'iMl health th* eomber taajr rMcb O.oon.OOO. 

S. McKiuT iriiea prto In citoi dnrtww i1i« oanbcr of rwl corpetdM, tftiUliy is 
b«iiiul |ati«DU. 

S. SjpbUU dimialihM the DODilwr of red MnraKta b«Io« th« bealtfa; lUudaid. 

(, llerourr in ijplilU* In email doan eanllnuvtl fur a *hoH or ions tim*, aloai 
wiitj i«diil« 0t potaHium, innr e— Uw ntmbor of red «uq«iwlc*, aail mainlaiBa 

0. HuTiuT in (nun dn«a d«U m • Ionic upon hMlthf uimaliv inenariag thielr 
*d|fat; but in brsw doata it ia deUlilatio^ 

<L lUtnuy In imall do«« I* ■ Uane, tor » limi at le«at, la iadSridnala ia tiia iMallh, 
and it Incrtaaei tLe nambet of nd MtpadciL 

The prolonged and and ne employment of merotiry prodnit-a Kcrions 
mim-hiff, lli« body waittca, lli« blood boconua nmcli impoveriehod, and 
" Biurcnruil foror''tiiaj be induced, eomelimod accompanied by pns- 
tnlar or vcaiirulnr eruption*. In nivrt-uriul tmmon wonknom in tbo 
upper exirtMnitica is first noliced, then volontary movenuata bc^u to 
lack their nvual prvciaion, and soon lOiglit trcmom aet in, and gmda- 
ally increase in aererity and extent till the whole body booooUM 
aSaetcd, tlio h'^ being itttiiclcMl bvfore the trunk. Theee la'cmon 
■10 eaaily excited, cannot 1w rontrolled, and pcrBxat for (N>ine tinio. Id 
•evero cmrm, almoct ercry part of the budy iw alTv('t<'d by Koruro Bpa»- 
modio movemtnta, bo Uiat lespintion is »|iaiunodic, and tluj vuSvrvr 
may be unable to walk, talk, or miuticate. Tbom may bo nonnlgic 
pniiui. Lotiii of oiemorj, bcodaolw, deliritun, and ercu eoDvnliiotia 
tuny oocur. Salivation ia Mmetimea abMnt ; for tlic mode of poUm- 
iog gtwtlf iolhieiKca the effect of mvrcnry; inhalatioti gonvmUj 
prndocing tnoiont inunction prodncing udirnlion. Innnetion, 
iwiwover, liaa produced tremors. Comjdeto recovery geaenklly titkea 
plaiw, pTuridnl Uw pattant ia ramovcKt f rotn the iiiHa«DCe of nieronry 
before tbo dt*eaae hai grtMly advanonl. The narvDaa aymplotua wn 
luually alowlj iirodocod, bnt they may oocnr after only n abort as* 
poearo to nwrcarial vajwnr, for Dr. ChrUliNon niirr«tea a caao whan> 
ono nig^lit'a oxpoanro to the va|)our from a pot of mercury oa n atovo 
prodocetl tremur which laatrd for life. 

Tha tnsUncal of mcretirial poisoning consist* ia tba nn of simplo 



US&CDKY. 



2^3 



I 



I 



or snlphuruas b&tbs, and o( iodido of pottutaiam. The iuSucnce of 
iodido of patnuinm on inorcury in tho njrstiMn ha« been sjiokon of 
elsevbere. ( Vide lodid* of PoUucdum.) 

Mercury waa formerly indiscriminntcly ndministorod in ft]] tho 
forms and stages of aypliilis. Given in enormous quautity, Uio con- 
iititationiil oSocts songbt to l)o prodncud wcrn very sorioua. Tlio bnd 
vffocta nndoiibt«d]y re«u[t!ug from iLo too free administratioii of tbis 
drug haro led mnny to diocontlnno its nttc in KTpbiliis and oven to 
ftttril>ute to tbo perniciouB iaflaeiioe of mercury many of tlie more 
aeriouji diHMMOH, lu dovCmction of tbc bono, &q., formerly met witti in 
typbilitic patientti. It ]iaa even beoii denied that tJieae graver loeions 
are ever produced by Eyphilie. 

An inQuentinl, thoag]i decltniag school of the present day, main- 
tain tbat nicrtiaTy is poworlom over sypliiliH, am) that the drug is 
Kimply harmful; there is, ]io«rever, a larger and more prevailing 
Bchuol firmly convinood of tbu nsofulneits of mercury wliuu jndiciously 
employed. 

The bctiiivers in tbo cSioaoy of mercury liold generally : — 

Tbat it ia good in both primary and secondary sypliilis. 

That it is of uxo in tliu treatment of the bard clmncrc on]y, And 
does barm in the soft cbaocre. 

That by the aid of mercury the hard cluuicre is more irpeedily 
rared, and the patient is less liable to secondary symptoms wbicli, 
ivben they do occur, are milder in character. 

That most forms of secondary eypbilis yield quickly to mercury. 

The following propaititionii are extracted from tho admirable 
lectnres by Mr, Jonathan liatchinson, to wboni medical scienco is in 
M many ways indebted : — 

"niit Bwrcu? b pnbftbbr a uug Tital ulJilaU iif^nit tht irpli'litiv *inn, anJ 
that it ii cup&ble of brisgiog aboot ■ twl oat*- 

" Tbit la tinctio<s * B°^ "^"^7 ***'* "* fetUr cond bf mgrciuT : tbe can iMine 
jvoTfd hf tho Tutoratloo to goocl hMltb. mi ia wmc oom bj' rsncwcd iatoeptil>ilit]r 

Is MDtAtfion. 

" Tbat Ibg ("''■^'""tT "f f'"* <)ap>iid* "poo tbe (lo^ of dtTclo^nnoat attiliicj hj 
llie dUwM vben tbo r«msd; ii reurloil to, ami Dpso bha perMYnraacs with irliUJi il is 
owd. 

" nat In ordtr M aceaiv Ibo aaljdotal «ISn«} o( meieurf i^unil irpbDI)^ It la 
■Ictinbla to intriMlaoe a eorutidarabie quan^tj into th« tjitam, ami to protriwt ila ma 
onr a rtaj lone timo. 

" That iiljalUm and oXbtr oiiUraco of tho plifilalogtcal agtian ot iueroai7, w Ux 
ftom being btneBoial. *i«, it pc«blo, to b« earefull; Bioidcd. mom tb«T pranat tbo 
(umcirnlljr iirnfongad nst of tb« ramodjr. 

" tbal In cuu In vbloli Ibo |iMt<Tit ahoiri an IdbMjncnuj pMDlUrljr Kuotptlbls to 
menutjr, tlio indiealion ia to nduot tbc doac. rallicrtliui to omit tho drag. 

" Tbat it ia impoanUa to hrein Ibo adninUtracion of mvroarjr too aooD, sad tkat !t 
ahoatd bo laaorial to, vllliont Icua of time. In all eaaoa !o wblob a ebuoro abova a 
Icndpni'T to indanitc^ 



274 



HEROPKr. 



" Tbftl maof euM of indnnUJ <huicrv. tmud *v\j by memaj, nmr aha* any 
ol tlM (tumcuriiUo •;iii|ilomii of Iho ■Monduy flMft, 

" TJut in lAhtc «Mn of mcrcatial onrc ot the cluuior«. in vhiib fM WMOiUrji 
VVptrau da wnpr, U»; u« uaillj nildu thfto it ftlloirod lo 4«v«lop witlioul (factflo 

UMUMQt. 

" ThkC vbcn miTcai; <Id« not wholly abngat* Ui« WMnilarr tU^, it eihibils • 
T«Diarka)ila |ia<r»r in ilflajiTiii it. 

" Tbal ilgiiTwI cmilinak* <i( Mcoedarf lypbltli arc U be ragaivltd nlher aa pnmt 
that tha adainUtnitiDii lud not Ihwd anffideatlr pcnorsring, thaa that tha mii«dj «■• 
not elBeicaU 

"That il in piubabl* that Uia (ink at tartiaiy (jmptomt U la tuio «llli tb« mtbI^ 
aii4 jireloDgnd Jaratbn of tba Mceuilirj lUgo. 

"That (hor« an aone croaaila lor t>«U«ring that Uie tnttaiy ^mptcna of aTpMU* 
aiB both Icn Cr«(|Oint tad ]i« tenn in tboat •ho hart bata eSelnilj trond tiy 
nttniTjr, than In «them, 

"That mcroiuj, tantioiulr fftva, Joe* aot, in a great majoriijr of ca««a, do toy 
iojarj ED th« gonanl hualtb, and thai iu local inoentonianMa nia; wiwU; h» pn- 
rmttil. 

" That the dvetrine nf tbe rfal antidolal ohaiMUr of metCoYy in r«ap«M U arpUIb, 
osght to load to DDrh mora imitoDgol admlolatraUon at il, irith tbo hopo at 4«ti«}rus 
nturtj all llostiisc b""^ 't the naiad]'. 

"Tliat moit fciUaetod ataUMiM aa to tbo doration of tMatncnt and tr««dMQ ttma 
ttlatM, aia miiltadlot and «om than oMltu, baoiaae niuatl} tbo trtatmvnl «aa tar 
IM ahoit to ha elTcetaal. 

" That it haa not jtt batn pnni tfant t1i<-t* ar* an; ip«cial tormi of aypblHll* 
dbraM In ■hich BMreorj oogbl to ba aTOicli^. altbongb, m a niloi, il la a«bMwladged 
Uitl II Diual be aa»d with more oantion in all lorau which are attondsd willi «k«>aillo» 
Ihui in othara. 

" Thai iodido a( potaaainin naiKMia Iktla w noaffltty ajalnat oltbar tha primw; or 
•tCOBdaiy (oma of •jrphilia. 

" That ibo tfGoaoT at nareorr la ofloa mnl algaaUy prorad tn CMaa which baT« 
uticrtj raitUil the action of Iodide of pobwaiaa. 

" nat il iof not nuMh inaltvr whoUwr Iho nmorj it gina by Iba nootb, by 
ianoelieo, or b; tb> rnpour lath, prorUed tbnt Mhal«ireT malhod U aetaclad, mv ia 
Itktn to anjid Balirvliiin. (lurgbg. Ae. 

" Tbit U» icaat anally reMrl«d U tor iDttnul aduinialntiaa, an tor tha BMaa 
r«n too lus*. ■>■>•' ('■■' (t"*) B » t aaa ll il t a prematura diMMtlniUBet at tbo nmoij, 

" That it ooo nolbod ot admUbtr»tion dota not praond Mtlrfartorilr, aaothar ahavM^ 
U liM ; aa4 tbu In no eaae ol diffienlljr tbouM th« nponr lalh bo forrotUn." 



Many other wrilcn agroe with Mr. Hntcliinson. Dr. KoyM of 
M«iw Tcrk TvcoiatDoiidi <ho imrcnnlUiDg oso of rnvrcnr^ for ai luwt 
Iwo jean, ui'l Mamrtunca lunger, iu aiiuiU dosea incnpttble of pit>> 
ilnoiii^ |)lipioli>f,'i(-nl ctfcoto. Ur. KoyoB enbirlAiiw Um botiot Uutl 
Rjpliiliaciin he t-iwlicnt^il. 

Most of tlu) fomiH of oongvniul iijpliilia of chlldnin enooomb to 
nicrcurj wilh singnliu- nitiditj. It U it comnuxn pnclice lo ^vii to 
rliiMnn aaaXl (low«, as a ciaarter u( a frraiti of gny powdrr. and tu 
ad<l to it a unal] portion of Dorvr's ixiwder to pravent rvlaxation of 
Uio liowcU. But I nra conrtnc«tI ihnt much Int^vr dflatii of fpvj 



Ubkcuhy. 



275 



pDwdn* are moro bcndidal, and rcmovo Uio <Iisea§e far more quiukl}', 
and sncceed, indeed, where the HTDall<T i]uhl> fiiUii. Tlirnt one, or even 
two, gminn of (frvy powder mny IxtgiTon tbniotimegnilay, iui|{xi&rded 
witli opitun, for it is Uie r&r«eit tluoK f»r even thtKc. dosctt (o pnrgo; 
nsy, if any dinrrbati oxigfas n not oncommon complication, these 
doses chec-k it. Iforeover, thej auij he coiititiuiil for n, coiuitlerublo 
timo, iill cvurj- aj-mptom hna vmubIukI, without prDduciii(> any of 
tile tozio eScctd of tbe drag. Am a rule, bnivt-vctr, imL- gmin of gmy 
powder thriuo daily in gnfficicnt. Tboso uompara lively rare forme of 
congenitftl disraso, where the pcrioataiom i> niTcotod, uMnally nrar tbo 
ftrtionlation of Boni<: of the long boaee, yield best to iodide of poUw- 
K-am (seo wis dmg], though, u far as my vxpcricnoc goes, it in 
still ne^^esaary in most etmes to resort to niorcnry to remove tie other 
eridcnces of ^philia. 

While ftdmitting the validity of these views, it b neoeasary to say 
thftt sometimes syphilitic pntimtj? arc appririmtly completely cnrwd 
withont mcrcnry, by moiv geiit-ral treatuipiit tendinfr to improve 
tho health; and further, if Iho h<iiilth in kwpt in gvod order, the 
BMOndary tiymptoinit will be of a mild chamcler. Casee of syphilid 
ooonr which are entirely nninflnmccd by morcnry, and arc carabli^ 
only by dili^-nt nttontiou Li> lliose hyffienio eiroamstancett which 
mend the general health. 

When oUier mmnn fnil, mcrcnriol fumtgutious, with stesmi, often 
Ksara certain obstinate syphilitic raahtM. 

Tho firmest beUovvrs in tbo efRoatty of mercury in syphilis, are 
unanimously agreed that to givo it in qiiuntitivH iinfEcit-nt to prednro 
salivation, is not only niiditHimblv, but jit-rnictous ; yet it appears 
that them preparations which ealirntoqnictcpsl, manifest the groat^wt 
power over till.- diK<Tiuu% and lienoo Uw melallic and meronrons pre- 
parations, as grey powder and calomel, am prwfcrrtd by »ome to thi- 
neronrie, as corrosirc Kublimatv. 

To prsToot or to mitigflto an attack of sick headache, it is u 
commou and often sncccMfnl pmctieo, to take a mercurial puirfj:e. 
generally in the form of a blno pill. Fur further saggostions ns to 
the employment of mercniy in this troublcmim.' affection, tho reader 
is referred to the section on podophyllum. 

It waa formerly thought that mcrcnry salts were endowed with 
the power of controlling inflanmiation, and to titie end they were con- 
stantly given, eren to nliration; now, howeror, theiruse nnderancli 
circnmstancca is mnch lea general. Uicblorida of mercury ocrtaiuly 
appears to be of f*ront uhl* in iritis and inflammations of the deep- 
seated parts of the eye, and in other inSarnmatinniFi, especially of tbe 
serous membranes, it is probably of servi<-i' in chocking tbe inllammn- 
tjon and promoting tho nbcorptton of dlhued prodnols. 



27C 



awfCB. 



Aeeoriing Ui Tny higli Mithanties, araoog whoai rasj be misa. 
tkoad Dr. Pwkc*. tauii <Imm of nloinel mj be uMt booaSciall; 
girai in tyfbaid tmret. It tboaM be prea nt tbe conuaeiieement; 
Bona tftink it am\etm after tbe tuDth or tenth ibf . It U ooasidend 
to Imboo the li«igUt of tbc fern', to Bbortcn ita ooane. to render the 
iBtMtiiuU ilmuigvmeat much milder, tuul to check the di>rrba». 
Bona push tho mnlicina till tbo extant mre slightlj toacbed; bvt 
tliic pmctice^ not oolj- tumeceMarr, bat bannfal, should be carofolljr 
KToided. 

TbcTv niv tome obaenstiooB, in [lart made hy Dr. Hnrle;, trhich 
t«nd to Mhovr that eomMdrc iDbLimatv i« a " h(«r1-|ioisoii ; ** for Uu 
hawt of an ammal destroyed bj corroeivo saUimate ribon rwinni to 
contract aftor death ; and tbe bort of a fiog anspcoded in a solation 
nf thia mUi, ceaaea to boat mach aooner than a heart auapended in 
|wre wai«r. 

Uerenry remainB a long tiroa in the bodj. and maj aconmalmte^ bo 
it ia Mui], in glubulM in the cuiceUoas stmctniee of bons. 

Uvrcoij aalts an to some extent eliminated bj the nrino, hy the 
mncona mcmbnuie of tbe intcBtincs, and with the bile. 



I 



PREPARATIONS OF COPPER 

AiTURD to the nntnokea akin, tho solnble ealts of copjier prodt 
no Tiaiblti eftcct. Thty unite with tbe solable allmmitionB anb- 
•tanoeB on aoriM, forniiog an insolaMo albnmiDate. which conta tha 
mriaeo, and, in an tmiwrfect manner, imj take the place of tbe lost 
cuticle. The thin pelliclo tliiu fomwd, ]>rotecl« the delicate 
atrartuTve froDi tbe air. and the Babstance* floating in it. and ao 
promotee the healing process. Like many oth«r metalii, theae mdtm 
ooodooBO tbe atraotunM and conitrini^c the Uood^veanla, and eo 
leaacn the siippljr tif blood to the part, and maj ereu arreat 
htaaunrhngi' from tbi? ■malUir vmboIb. Thojr act a* irritanla tu tbe 
dolioato tittaoe, produoing alight inflanHoatioa. with aoine smarting 
pain. 

Tn ammt bleeding, and as aa irritant to indolent sorea, tbe 
mlpbata is must oniployed, either in otick or eolation, or as an otnt- 
nwnt. 

Indolent forms of imjKHip>. after reatstlng the more usnal appUcHr- 
tionn, will M>motim»< yiuld to siilpliata of copper. 

Id tinea tarsi tho solid sulphate maj be mbbed, ofton with con. 
■pii-uiiaa ndvnntagv. uloni: tlu' i-tlgvS of tliu rvclids, tho djHlaahua 



OOFfXii. 



277 



I 



barin]^ betin previoiisly out off closely, aiiil tba acaba carofalljr r©. 
movod. Indooil, in ovcry cftso wbwo sligbt stimulation U tt!qnirt!d, 
tltb fall may be used. Milder id its action than iutrat« of ailror, it 
«jcit«B itmch less pain. 

The soluble *a]t« combine in the mouth with tkelifinid albuminous 
substances of Uiis cavity, and precipitate tbem more or Ima com- 
pletdy ; but, if tued in quauiity moi-o than *uflidcnt to do thin, tbe 
mncoQS membraiw iteclf t« nitavkcd in a manner altogether similar 
tn tbe abmidcd sliin. Th&ie salts pO(nie»s a metallic styptic toatv. 
Tbe Bulphato, in tbe solid fonn, may bonppliod with advantago tolho 
spots of paori&iiiii, simple or specific, or to indolent sores affecting 
the tongue. Painted in solution over tlic wiges of ttit- gums in 
alcemtive stomntitin, it generally quickly bealB tbe ulcerated 
anrfaoes; bnt on tba whole, dried alnm iit to bo puforrod. 

A weak solntion of this salt painted over the mucous membrane, 
will remove the white curdy- looking coating of tbrusli, nnd prevent 
it« rcnownl. 

The solnbto salts in the stomach bohaTo in the same manner as in 
lliv mouth, and if tukeii in largo <|iiautities, ad as powerful irritimt 
poisons. 

These saltii are emetio; tbe snlpbate, being speedy, and moiitly 
effectual is not unfrociuently prcscrilx^. A good way to give this 
salt as a vomit, is to adminster il in Hmnll and ri-equt-ntIy-re)ieaItK] 
doses. It generally producos oneoopious ovacuation, ndlhor purging 
nor producing much nausea or prostration. It is supposed to exert 
an especial action on the larynx, henoe it is sometimes given in croup, 
and when it is ncecKtary to expel any obdnictire Kuhatanocs from the 
glottis by the mechanical ofTorts of vomiting. 

In modento dosos, the nalta are astringent to the mncons mem- 
brane of tbe iutOTtines, The snlpbate, administered idthur by tho 
month or by injectinn into tho rectum, is often cIToctual in staying 
soren chronio or acute diarrha«> whether or not dejionding on 
serious organic diseascL 

CoppiT salts, taken for a considernblo time in Kmnll quantities, are 
■aid to give riao to a condition not utdike that produced by luiul ; for 
example, colic, with alternating eoiixlipation and dinrrfaaea ; and, it is 
even said, paralysis of tho upper extrctnitieH, undintinguishablo front 
tliat of lead. 

Salt* of eoppoT 6nd tbrir way into the blood, exifiting there prob. 
ably ax idbominatos. 

Urs. Levi and Barduxzi find that saiall doticw of sulphate of copper 
promote ammilation, and increase strength and " Itesh " iu man and 
animals. They are used with beoiefit in erythema, eoUiyma, ocxema. 
HUTofnIa, tubercoJosts. Copper, (berefoiv, appears to act physiologi- 



278 



XIXC. 



calij nod tli9ra])oiiti calif luncb like arsenic, and like it, slionld 

taken with, or soon after, food. 
Copper salts linve been ^iven in cholcm bnd epilepsy, 
Solations of tho salplin,tv nro rwplojcd in gonorrluM, gleet, and 

leuoorrhcra. 

Copper is elirainated both bf the nrino and Uewm. 



PHEPARATIONS OP ZINC. 

Thi merobore of ifaia ^ronp are einplojed in various vraja ma ex- 
tereal applicatiooa. 

Kren in (lilnto iiolntioiin Chloride of sine destrojs low OFffuUBOd 
fornut, and is llina disinfectant and antiseptic. 

Tboir pomninn action ia astringont and irritant ; but on acconnt of 
their different dejnveK of xolubilily, their Taryiog afKuity fur wat«r, 
and porhapa for tlio tiiignce, the aovrral incai1>en of thin group mani- 
feat these propcrtiea in tuieqnal degrees. 

The chloride and iodido, from their high diETuMton-powcr and irreal 
ftffinitjr for itatrr, are the moit eaerrcetic, yet even these reituiin ftU 
moat inert on the skin, nnlcsa tho caticlo ia first removed, when thej 
pormeate the tissues, and deatroy Ibem for a considerablo doptb. 
The ohiorido at fint |iro<lnccH a aensation of warmth, wbioh tDcneMlw 
to a bamin^ pain, UatinR eeren or ei^ht honra, by which timo the 
tisauw SR! dcMtrojrod, and a whiU) eschar in formed, which Bopanttea 
in from seven to twelve dajrs. T)ic chloride and iodide, as w(> bave 
just Mud, have hitluirto Iwon rc^rdod tui the most enei^tiv salt* of 
this aeries, hut recenlljr Mr. Marshall, of Dnirorsitf Oolle>)te< bna 
ttliOWD b; experinumta that the nitrate penetrales deeper than the 
uhloride, destroying tlie tissam to a ^(reuter dv)>th, and, aocordin)^ to 
tbo Mkino authority, possesscH the fnrthrr n^lvanta^e of ]iro«lucinf; lua 
pain than thi; <!hloridv. Thniu three pre]mnitionK, hut especially the 
chloride, are applied to n«vi, warta, condylomata, the skin sdlooteil 
with InpUH, and the tissue of Ny|ihiUtiu nlcen. 

The sulphate having a lower iliffuiiion-power, ita action ia lutteh 
more snpcrlicial. In commun with the oilier soluble salts of xiiic, it 
fcMins an insoluble compound with albumen, and by virine of ita ma- 
trinfianry condenses tho tismtrs. and contracts the blood-veawls. Aa 
n stimuliint and aKtrinKunl it Iceseitf the seeretions, mad pnNaotea 
iHialiliier ftrowih of ill-cniKlitionwl, froc-a o Bre t ing sores or eroptleaa. 
In Dominon with the chloride it is used as au injection In SonotrhcM 
or gleet. 



I 



ZISC. 



270 



I 



A gmin or two grninii of c1iIort<l« o( xiuo disaolved in a pint oE 
wnter, and a iiltio of this solution injected hourly daring tho dxj. is 
often aida] in gonorrluvo, if trcittcd at its rerjr beginning, romoviag 
the disease in twenty-foor to forty>eigkt Itoim. Rost, if poauUp, 
itliould Iw oldcrrcd ; Init tliiii in not indispeurablo. If the freqnont 
injection causes nnj paiu in the teeticlra, tlioy shgnld be sosponded, 
nnd frvqucnily fomented viUi hot irat4ir; if, niHwithftttuuling, th« 
pun coDtinaos and the swelliiig incrmsM, tbo injection miut be oin< 
]]loyed leu often. 

A solntioa so weak as tho ono rocnmmondod ie no better, it lanj 
be eaid, than tiimplo ynit«r; bnt the. fuel is, eimplo water doesi not 
cnro with anything like tbo enmo rapidity. If oomu of this solution 
ifl tekea into the mouth, and retuued there a few aeconds, it will 
prodnoo a decided ronghnoes of the mnoona nieubmno ; now, if the 
Bolatien in ntroiig tmough to aifeat the mncoos mumbnue of (he 
monUi, it out certainly inRnoncv, in at Imul an equal degree, it simi- 
lar, bnt more Kcinaittrc, ntructure in the ui-othriL 

I'ho carbonate and oxide are iDHilnblu, or bnt very slightly solnblci 
in thu noimai flnidtt ; and as thc«ci Kult« |>»Ntc«« no adiaity for water, 
their action on the tissuca is very weak. They are. however, slightly 
astruigunt, and are oMftil on account of this property, in ointment, 
or in powder. The ointinvnt of the oxide ia used as a niild stimu- 
lating application in ooiema and itnpoti^ when infbunmntion baring 
■ttbsidod tJte law sorfaoe is left in an indolent stale, with very little 
disposition to hcftl. Both the oxide and oarbonntv arc used ae 
dniiing |K>v.'der, aud mo, pt-rhops, the beet powdors for this purposo ; 
bnt, as a rule, Krc«iiy appliciUioDM are preferable. In inOamod con- 
junctiva, a weak aolntlun of Uie snlpbato dro))pvd into tlio eye scTenvI 
times a day in oft«n very uwfnl. Tlie wnMi salt is oooadonally em. 
ployed aa a gurgle in relaxed k)» throat, and is sometimes added to 
•lam iDJacti<ma for leucorrhces. 

The more solul>)o pruparutions poaaess a metallic styptio taste. 
None are omployotl in diseases of the moaUi. The L-hlorido hns been 
luod bo destroy tlie vxpoitcd painfu! pulp of dccayod teeth. 

The carbojiate in largo doses ]>rodnces some nausea and Tomitiug ; 
bnt a full diMo of tbo snlpbate acis much more ^poudily, is a safe 
emetic, producing littlu prostration or naniiea, and gvnerally empltea 
tlui stomnul) in one complet« evacuation. It is, iheroforv, the b<»t 
emetic in cases of poisoning, being far proforablo to Ihu slow and uti- 
snro action of ipooacnaalia. It may bu employed iis an emetic in 
bronohitis or croup ; in brondiitiii, to oxpol tbe mucuji from tlio 
brondiial tubes ; in croup, tlio false menibrano fram tho larynx ; bnt 
otlier emetic* are mostly profvrrvd. Tbu sul|)lia(o may 1x3 employed 
as an emetic, or in dosea short of the induction of vomiting, in pain- 



uxc. 



fa) affections of the sUimacIi, dcpmdent on chronio tinflamnaation of 
the mooous membrane. No sstififoctoiy cxplnnnlinn luu jot been 
given of tho actjoa of sino salU fls emetics. Tboy vomit even if 
mixed with albnmon. iDJoctcd into tho blood, the Rolphato exoitM 
Tomidng. 

On socount of it* tiight solDbilitj, tbe oxide oxerta bat slight 
nction on tho stomach, little being dissolved unices mnch ncid is 
present. 

Dr. Brackenridge stronglj recommends oxi<lo of xinc in two to 
four grain doaeit erory three boors in the diarrhoea of children. 

The cbloridoisa comBivo poison. The pmlphate.on nnyiTint of its 
ostringencjr, tike motet other metAlUo Malta, may bo employed in lUor. 
rh(>'ii. ftti action must take effect on tho uf^icr part of Ibu coaal, 
aince the portion tnoaping abecirption mnst he speedily converted into 
an inert imlphido. Tho stomach may become habituated to tho ia- 
gestiou of very larfre doaca of the gmlpliate, to th« extent oven of 
forty gnvins tlirico daily, witliont obvion* b»d roanlts, or witbont in- 
dnein^r either naoses or vomitintf, or apparently any alteration in tho 
muoonit membrane of tho digOHtivc eanal. Ah it hn« hocn ahown 
that sojierBcial ntceiwtion of the stomaoh may be produced, the pro- 
long^ omployment of snch doMa is impmdcnt. 

!^nc ooUo baa been deeeribed with aymptoms including oonBtipo- 
tion, vomiting, prostnttion, with dintgrooablv UuiU) in thu mouth. 

Zinc finds its way into the blood, and cxiata there probably as mu 
nlbaminatc. 

The oxide and tnilphate have been employed with advantage in 
epilepsy and wliooping-congb. In hromido of pobiKiuum wo now 
pouesB a better remedy for epilepsy. 

Sulphate of ainc if often very useful in chorea. Like tartar- 
emetic, it KDoeoeda best when given in doaes anfflcieot to pnxlaoo 
DaaNM, or even vomiting, daily. To effect this, howei-er, tho doae 
mast be ra]tidly intTeaacd, mimetimes to tlie ext«nl of two gimins 
vvery two hoars daily, nnd it in astoniahing how mnoh of thin dntg 
can be borne, for I have given fifteen and sometimes twenty-two 
gntina every two faonrs withonl prodnoing naneon. Thns adminia. 
terod tliia salt oltm effects atriking improvement, Imt tbcM herolo 
doBOS after a time i-xcite pain at thu pit of the stomach with Iom of 
appetite, and when this hnppena, another emetic, like tortar^atotic, 
may bo anbatituted. Wlien given (o excite nanaea, it ia a good plaa 
lo Bilmiiii>l«r n dose before tiraikrnal. 

It is a noteworthy fact that most emetics ore naeful in phorea. Do 
they act by exciting the physiological state of nantea, or by tlurir 
operation on tbe ncrvons eimtm through which emetica prodnoo 
nnnBoaP A» tnptorentcut occura in many casoti indopondcntly of 



I 



I 



UTIUOXT. 



281 



tho indnctioD of drumOi tiio iDtttT roggostioD is probably tlia mora 
feAKible. 

Zinc >alU ore rcpnt«d to Iw powerful " nemne tonics," a somowhat 
vngue expression, meant, I aupiMHC, to implj tfant thuj^ promolv tho 
nntritJan of tins norvons Sfstem, and somo aothoritiea ftttribato to 
this property the ioflaenoe of thrao salts in ohom. In certain fonns 
of lifRtertit zino mltfl aro nioful, ospeoiftlly in the sbapa of the valor- 
iannlc. 

7Lcn Hubstancon aro ropotod to bo luitispnemodic When thoj* 
produce nausea no doubt tiiey iudireotJy act Uiuh ; but it la doubtful 
whether non-cmctic dosoH arc efficient anli>pnsmocl)ca. 

The oxide in two to four grain oiphtly dosos often ooiitrols profuse 
colli qnativ 15 nwca ting. H in mid also to dicok tho profuse secretion 
from the bronchial mucous menibmno in some forms of bronchitia. 

Dr. Hammond reoommends oxide of zinc, in two to fivo grain dosos, 
for norvotu headache. 

This metal docs not bonomo 6xod in tho body, nor doos it, like lead 
or mercury, produce chronic affection. Zino sal(A are eliminated from 
the body loM rapidly than sonio other metals, passing ont in small 
quantities only by the uHno. It has been aamerted that very iittlo of 
the salt* pass into the blood, which may bo tmo ; but the fact that 
tho chief part may be re-obtained from the ^pcgs is no proof of this 
t<tut<^>nont, as xinc, like many other motalii, i* jnroliubly cxorvtvd by 
the mucous membrane of tho intestines, and with the bile. 



PREPARATIONS OF ANTIIIONT. 

TiiiUMnRTlO, in tho form of ointment, excites in the skin a fhar. 
Mtsrirtio isRamuuLtion, at first papular, tbcn vesicular, and lastly 
putnlar. The rash tfana ranu tho counwi of tho vrnption of small- 
pox, and in each tinge simulates it very closely, though there ara 
points of ditlerenco distinguiidiablo to a pnictiiiod eye. Like imall- 
|»ox «'mption, this rash ofton scan; moreover, the capricious and 
|iaintnl action of this ointment nmdcrs it an nnauitiiblu external 
application. 

Tarlar-emetic ointment oaod ycstrs ago to bo omjilnyed, lhou|:^ 
now rci7 rarely, tut a counter-irritant to obtain a powerful perwstont 
itcli'in ; for inntunce. to the scalp in tubercular meningitis. 

Chloride of antimony is a powerful csoharotic, bnt it prodooos an 
jll-conditionod, slow-facoUng Bore. 

Tartar-emetic being the noiit dwkI member of this gronp, oar 



AMtaOST. 



remarks, except wlien th« contmiy is itftted, vill np[dy to tbia 
prepustioD. 

K^fter small medioinal ilo»e« the stomuh espuioiiAoa a alijtlit ttta- 
Hftion ot Koronoe^— & Honefttion oiwil; mixtakon dir hui^r. PtutlwHl 
]%t further, tlio dru^' produooB increftaed seoretion of mucus Irotn 
tkv tlomiich nnd intvntinvit, to tho cxtmt of indocuig nniner(>tts moist 
inotiona; and diarrhu<a with oolio niay set in. The broDcbiol nraooBS 
membmno aIko yioldfi an mi^rpiuiMl eocrotion, and probably the M0r9* 
tiOD of the whole mnooua tract ia augmeDted. 

Antimony i» iiOTur lucd lui a jiurgativo ; in fact, 0])inm ia fro* 
qnontly given in combiDalion with tarl&r-emetic, oxpruasly to prevent 
[Mirgation. Large donvH excite nitniK-A and vcmitinf;. Aa an vnutvci 
Urtamod antimony prodnoai oonaiderable di-ptvBsioo. with msoh 
naaacnt in a greater dogroo than most othi-r cmeticM ; and the repMlad 
vonuling ia aocompaniod by ffrent stimuing. Its action ia somewbal 
tordj, sonuttimoN twenty minntca to half on huur, buncu in cnaea of 
poisoning it is on onanitable ometio. 

Majendie has iJtovrn that when injoctod into tho roinal*rt*i-«nMtio 
exoitctt nausea, even after the removal of the atonuteh and its onlwtU 
tntion by a pig*9i blailiier ; hence it h» gsnerally been held that thia 
aalt prodocea vomiting, not by its effeota on the stomach, bat on the 
nervona oentree. Grimm, wlu> is confinni^l tiy Klcinuuin and Simon- 
oiritauh. fiuda that when injected into a vein it excites Toinitiny 
more slowly, and a larger dose in roqnirvtl than when ndniiniHU^rad 
by the stomaeh, whence he conolndcs that it prodocea vomiting hj 
its effects on the termination of the ncrrus of the Ktomoch. Be 
dicposee of the diHioalty r^«ed against Ihia view by M^endie'a ex* 
perimerat, by aaanming that tartar-emetic exoitM nausea hy iu effect* 
on the terminttioo ot the norrea of the oeaophagns and intestines. 
Other obnorvcrs explain the foregoing facts bjr the supjioiiition th»t 
tartar-entotio acts both throngh the terminations of tbo norrca of tho 
stomach and directly on tho centra for vomiting. 

Tartor-emelie was formerly rmplnyod tu induce nnaoolor weokneaa 
BOil ivloxfilioB ot spasm, to faciiiiate tho mtaotJoM of didlooatioaa 
and bernio, bnt in aaeh cnsn chlotofonn boa now complotoly 8B)iur- 
aeiled it. 

Tronssean taught that food inflneooes gnatly the action of ftnti- 
Buitiy, H low di<'t favonring tho production of ilN oonstitutional 
effects, and a full diet ita emetic nnd jtutgative cITocta. Ila aetion 
is fnriher modiliod by tho (innntity of water administered wiih it| 
this being small, vomiting takes place, if bugLS diarrbcM. TnmaaoMi 
further ohsorred that certain sabstnnoos modify ibe effects of anti. 
noBj ) for (rine and acid fruits, both freelt and preserved, develop 
its ODMtie and pnifjativo propertiee. 



i 
I 



ASimiOKi. 



283 



The solabla Bnbnony eomponnJa casUjr enter the blood. Init U>o 
form they assmne there is nDknonti. Poosibly tho oxido of tltu 
metal, either in the Ntamach, intvutiucit, or blood, ooubinea with 
albumen, iornuag on albuminate. Antimony compounds, it is snJd, 
do not combine with nlbamoo, except in acid aolntionit, whon an 
insoluble cani[jonnd in formed. 

In antimonial puisonin); there is'grmt motor and aonsor; pumlysia, 
and loM of reflex action. The lou of reflex notion and motor povor 
HAdxi«jeweki shows is dne to tbe effect of the tArtMr>emetto on the 
cord. ThiM anlt a1»o ponorfnlly nitootc thit heaK, in tlie frog slowing 
and then arresting it in diastole ; and it aSecte the heart of warm- 
blooded animnU in the same way. Tlio arlurial prcMare falli greatly. 
VVhiUi tbe poke in slow the diastolic paaaeiB »ra hxog, bat each Ixtat 
inflaenoes the mercnriul column of the oardiometei' five tiroes nioro 
than DORiud. After a large dose the pulse at laet booomeH very fre- 
quent and fwblo^ and the heart stops in diiuttole. Tartar-emetiQ 
directly affects the heart ; aSects it i>ven when tlio heart is removed 
from the body. Radsiojewsld faa« shown Uiat the ends of the vagi 
are paralysed, and Aekermann Chat the oontractilily of the ordiao 
mascio is destroyed (Wood). 

In the Jirnmal of J'hytioloyy I have pnbtishcd in conjunotion 
wiUi Mr. Murrcll some eiperimente showing lliat tartar>cni«tic, like 
potash-Mtlta, arcooions acid, aoonitia and hydrooyanio acid, ia ft 
protoplasmic poiaan wfainh destroys tbe functions of all tlie organa of 
tbe body in iho order of their vital endovnumla. Wo have ahown 
that the general pur&lyais which eutuea in a frog in tbe hypodermia 
injection of tartar-«motiei is duo to tho action of the dmg on tbe 
Bpinal cord, thna conSriuing preiviousi experimenters; and that tartar, 
emotio ia alao a direct paralyior of the motor nerves, and of tho 
maaoles. Our experimsnU confirm the oonclnsions of prcvions 
observors conreTtiing tho action of tartur^metio on the maacnlar 
snbetaaoe of llio boarl. 

We have thuH i^liown that tnrtar-ometie paralyses the central 
nervous ^atom, the motor nerves, the mnscles, and <lestroy« sotuta< 
tioD, and thorefoi* wo an led to infer that probably tartar>emetic is 
a protoplasmic poison, destroying function in all nitrogcnons tissn«. 
Oar experimenta, however, ttil to show whether it manifests for all 
nilroganoaa tisanes an Miual affinity, orwbother it has a special actioii 
on some^ 

Aa in the com of potaali Mlta, araeniona amd and aoonitia, tartar* 
emetio, we anggestk weakena or paralyxm the heart tlirongh its action 
on all the tissnee. ganglia, narve«> and mascnlor sal)stance of this 
organ, affeodug first (he ganglia, then tho norves, aud last the moa- 
calar sabstanoes. 



2S4 



AKttUOKT. 



Tartar- emetic ia a i^cral as well as a cardiac deprcMant. Tho 
general dopros&ion is nsQAlljr iittnbntocl to tho action nf ifao drag on 
tlic hL'nrt, but, iia aotiinoiiy ia a poison to at] nitro^ooas tiasiuM^ I 
woal<l snggmt that ils doprosstn^ action ig dno also to its eSeeta mi 
tlie centra] nen'ons systoiu, tlie uervea, and the miuclM. 

Wo noticed a poculiar pSteet of tartar-ometic on the skin. iDa 
few boors the cDlitde of a poisunud fro^ became eolt^ned anil gvlntisi- 
form, too soft to bo stripped ofT, though it oonld bo «uily scraped off 
every part of the body. Evim small dones soon prodnoe thin mmae^ 
able effect, for in one experiment the skin, after a small <loBe becadl 
in thia CKmdition ovun whilxt tho animal conld still orairl prellj' ww^ 

MiiB Nonn, under the direction of Dr. Michael Foster, has care* 
fully vrorlced out tbe effect of tartar-emetic on the skin, and tbo 
resnlts are published in tbo Journal of I'hynnlryys, 187^. I shall 
refer to her investigation in the article on uisenic. 

ll has been prorod experimental ly that the administration of 
tartar>einotio increases both the initeiutible poritpiration and the 
vaponr from the lungs, but chieBy the secretion from the siciu ; and 
sinoe at the stage of naosea all emetica iDorenso the sneat, it is diffi- 
cult at present to decide whether tartaisemetio has in this raspael 
anjr special inflaetioe. Tartar-emettc wine ia commonly f^inn as a 
diaphoretic in ferors. 

UndcT the inBnence of tartar- emetic, carhoaio acid nnd nn-a are 
both eltmiDiil«d in greatly incrcaaod qnantity. Whether the anti- 
mony is to be considered a mere eliminatur of these oxcn'mcntitioBS 
sabstanees, or irhethor it likewise increases their formation, in not 
dsterminod, ue the experimental oridenoe is as yet inadi-quate to 
dceidu thia cgncAtion. 

In common with other emetics, antimony is somctimen girea in 
large dotex, to produce protnso nnawn Hn<t vomiting, and many 
eminent anthorities, amon^t whom ranks X>r. tirares, hold ilint the 
stnnig tmpmwion tbos nuule on the KyHtem will cat short nento 
(qteoifie fereH and inflamnuttioua. Graves held that typhus mif^t 
be Ihos summarily checked. Tlie period for the exiiibitian of em«tias^ 
ho states, is very short ; for they vrill not soeoeeil after the tapM of 
twiMity.fonr or thirty^BU lionrs from the occnrreoce of tbe rigor. 

Alany oases of a^e nay be ounNi l>y lIiv impreasion emcticn tnaka 
on the system. An emotio iidrainistered each memini; will help the 
action ef qninine. for cases relM^lioiui to i]ninine alone, oftm jlaU 
iniMiediately to (he joint action uf <|uinine and emetics- Ipecaonaaba 
and oUier emetics shonld l>c prrfemNl to antimony. 

Antiatony will not lower the leui|)t'nitnrv of the Ixidy of u Itcsilthy 
peraen, if one experiment may be aeocpted a* sufliciunt to aettle thiit 
|H)lnt. To a siiieng young man I gave tartatMmielio in half-grmin 



AXIIUOKT. 



285 



I 



dosen eveiy ten minati?s for near!]* seven lidore, iuducing gre»t, 
nftQEOQ ami vomiting, witli pntfuno pcnipirotion ; but daring tfao 
whok timcbiH temperatnro remained remarkably con&tiuit, vaiying 
not more tliAn O'l Fslir., an amount of deviation froqaently observed 
i&hcaltb. 

T»i4af«(netic acts in maay rospocta like aconito ; giv«a in )>, lo ^ 
gntitl doW8 vnch bonr to u fever pstiont it produces on]>ions porapini- 
tioD8 and HlawA llie pnlse. And with the porflpimtioD, reatleeasMS, Ae,, 
disappear, In -^ gnus doiei it often excilun tr«ublMoiao atokntM, 
even in adnlta, and it is bottor Uicroforo to begin with * 3^ to j^g grain. 
In my expcrionco aconite, tartar-emetio and enrbonnto of nramoDia 
aro the mwt ]}UWOi'(ul diaphorvtics in fovcr, nnd next, ihongh a long 
way inferior, aootato of ammonia. 

Of late years antimony has been maoh employed in acute pnon> 
monia, and the general oxporience of the proftwsion ia Mtroog in its 
favour. Diaoretion, however, must be nied in adapting the dose to 
tbo Blrongtlt of the patient, who if weak, mnst meanwhile telco 
alcoholic stimuhuiU. Under the inflnenco of antimony the pain in 
the side gives way, the expeotoration from maty cliuugeH to bron- 
obitic, the poise and breathing become redoced in froqnoncy, and in 
many caaee the further spread of tlie inflammation U cheeked. 

Other kinds of acute .infUunmation may be similarly ti-eatcd, al< 
thongli the good resiUtH are not to itp[ian:nt an in pneumonia. Unlesa 
the tartar-emetic is given at the very beginning, its powei' to control 
pneumonia ia much lew marked. 

Antimony will shorten and moderate attacks of feverish oold, 
tonsillitis, pleurisy, orcliitiM, Iirondiitiit, jmorjiernl peritonitis, iiifljim- 
mation of the breast, whitlow, and other inflammatory aBoctions. 

Antimony ia neTvioeable in ohronJo bronchitis, nhen the expcctorn* 
tion ia copioos, frothy, and difficult to oxpol. 

In tlie following diseam tartar-emetio b invalnablu ; — 

A child six to twelve years old, on the slightest vxposnra to cold, 
is attacked «ith much wlieextng and some difllonltyof breatliing, 
•ometimca m nrgent as to compel him to sit all night propped with 
pillows. The exiicctoralion may be pretty abundant, but a chiltl of 
this age does not generally expectorate. On Itstuning to the cheat, 
there ia heard mnob sonoioiui and sibilant, with perhaps a little bab- 
bling, rboncas ; bot this last is often absenL Tlio wheeaing is 
audible for a oonsiderabte distance, and sometimea tlie noise is ta 
great as to be beard many rooms off. Occasionally the congh ia 
troubleaome, and on eaob exposure to oold the voice ninj beoonio 
hoarse, and the cough hollow and barking. Some children become 
thna afflicted whenever Ihe weatther is cold, oven in summer, and may 
not bo frco the whole winter: with others the attack Insts only a few 



S86 



ASriXOSY. 



ireelcB or d&fR. This affection somotirnM follows inuwlsa- It in DM*- 
jpaxnd bf tlic molhor to aHthntn, with wlueh, if oot ideutiool, it i* nth 
Uinly aJlied. 

Tilt) bod mty to udminixtor tiun mII is to disaolva a fnitii) of il 
in balf a, jiint of wator and to (pvo & teftspoonfol of tbo (K^utioa 
tmry quarter of lui hoar for the Brut honr, afttfnntrds honrlj. U 
the wheeling oamw on at niglit, it i« sutBoimi to giva the medieitie 
at thia time only. The: gmiil cfFouts of thu mmlicino boooioo spmiiil; 
ovident; for on tho vmy firat night it ofttyn gradtly benofite the 
child. So wnoll a doiw, it inajr bft tbaught, nuiit be inofB<>acioti«, bot 
when first given it geacrally fiTvdncf« vomiting oneo or twice in ibo 
dnj', »nd, OK it in not nonenmrj to prodnco Biokn<iM, tlio doao ia thri 
OMO mtLHt be tttill Bm&ller. 

Thoro ijt, howwcr, an nffcntion nnafFcctcd by tortMr-^tnetic 
what Kirailar to tbnl joat dcHcribed, mhiob it is oeoeeBary to diaomai- 
nal« from it It ocunr* in children n. hit month* oH, and coiwista at 
& load rutllinfir, wbiob is obriooslf (paused bjr mucnH in tho throat or 
larjrnx. I>i some ojimik thn rattling in wnreo in thv dajr, bnt ia nanftJly 
wonw ftt niifLt. Then- i» no bronchitis, or tf there ja, this is a rnvrv 
ooinoidoncc ; nnv. Komutimot on tho occnrrcnoe of lirunfihitis iiio 
eomplaint in qneiftion cuws for a time. It is bronght on mud 
■g^rs%'atcd hy cold, and mnr lost, with wm« AnctuntionH, manr 
monthg. 

Antimonj in KRtall honrly dci*c« ix rvn,- Dtwftil in tho acntv cntnirfc 
of (;liildr«n, Bonietimt'M nccompnnivd bjr vomitiuK and diarrliow, frcH^ 
ablj dno to catarrh of the intMtinc*. Tbi» intestinal canal ia aomo* 
timea the Bnl atUtclciHl, Init most fruqucnt))- the lunga arv dm 
imjiHcatitil. Tlic ijtrtar-ometio gvnorelly (jnicL'tj* stavtt tho vonitinir 
and diiuThu«, but cftm tokm a longer linke to control the bronobitJi. 

Anlimonj- acta u a doprMsant on IIm) heart partly' tJiroagh ila 
BaoMatiDg tDflnMtoe weakening and increasing tliu frequency uf the 
oontiactioRS. 

OrnrcH omjiloTod antimoiij in typhna and other fcven, when then' 
is much eicitcmont and furious dolirimn, ^mptons which mv 
({onerally subdued bj th« exhibition of this dmg. As walcnfnliMiM 
is ft conoomitant symptom, being iniktvl the ushm of thu ox<7it«ni»nt 
and ddirium, opium iibonlit be n4ldnl to ilio antimony. Thi* ciaiD. 
bined influence of them* remi>di<-s olros the vxoitement, and intlncen 
letraaliing aleojH ontof which the patimit wokiH refrodioil and ttw 
fraoi ddnsionB. Judieionsly employod, thosu remedies inaj- savo itn 
altnoal 1io{k'1i-«>i lifn. t^h dmg appears to assist the action of the 
utbtn-i and the nihittve doses must l)e determined by the cin*tint- 
Hlanoea of thn cose. In furions delirium Ihn lartar-4'miTtiu nmat Iw 
given in fall, and the opium in small ()niiutiticMi while, tf wolcvfnl. 



ASnUOST. 



1W7 



I 



noM prcxlominittoi with not very boiatorons delirium, the dose of 
tartor-onietic ninet bo redncod, nitd th« opinm incrtiiLcod. 

CimvvH lulvincA ono-foorlb to bnc-bftlf a ^Ttun of the nit every honr 
or two bou», to be dificontinatrd when it produces biliotu Ktooln. 
I'hii; truntment is wry nMfnl in the dL-linuin which usually sets in 
ftbout the ninth or t«nth dny of tjphnp. 

The nuuiia niid Kkt-pluitinunH of dehriam tremenK geuerully ^voa 
wht to the same treabncnt, 

PtKirpcml mikniii luiij be treatt^d in the same way, although prob- 
ably bromide of potoBginm and chloml give butter rmnltK- 

Tartar-emetic given to the extent of prodndug nausea aid 
vomiting once or twice u dny i« soiDetimim nxi^fa) in oboren. (See 
Snlpbnto of Zinc,) lucrcotiinK doned must be given, as the system 
appears soon to loloratc it. Otbcr rcmodicRi however, mn mure 
effioiont. 

In Btnunoiu ophthalmia, tArtnr-emctic may be gircn with odwi- 
tago, in doBOs of l-3(!th to l-48tb of a ^j^in three or four tim«B a 
day. Sharp jmrgution nt the comiaaicfflnent of the treatment is 
highly nse^. 

la aonte polauning by tnrtor-emetic, violent and oontinnons 
vomiting ncwnrs, accompanied with a diarrhcea of biltons and bloody 
stools, and sometimes the common tymptoms of gantro-ontoritis, and 
Homctimcs of peritonitis, niv present. The prostralion is intense, and 
]>rofoand ond repeated faintingn take place. The respirations and 
the ])nhie ore said to bo redoood both in frcquonoy and in strength ; 
others assert that the pube is more frequent. 

The pott-mort«m appoamncos are intlammntion of th« stomach and 
intestince, but not ofl«n of tlie gullet. The peritoneum may be, and, 
according to Harloy, the rectum often is, inflamed, and some Lnflam- 
uiatiou of tho lungs is nanoUy observ-able, leuding to make it 
probable that tariar-cmdie exert* on Mpocitd nation on tbenu 
organs. 

In tho trcatra<!nt of poieoning by tarbtr-cmulii', thi: vomiting 
should bo promoted by wanu demulcent drinlut. while strong tua or 
coQ<M', tannin, or decoction of onk baric, should be diligently adminis- 
tered . 

Tho statemunttt eonocming the inllnenct' of autimoiiy on tho nrine 
are conflicting. The proh^Wo effect of tnrtar-pniclic on this excre- 
tion in to lesson the amount of water and of chloride of sodium, 
owing to inereoaed porspimtjon. 'I'ho urea is greatly increased, 
apparently to proportion to tho dose ot the ontimoAy, ao is the pig- 
ment and nric acid, bnt in a lees degree. 

Tbe golden mlphnrot inerfoscii all the ronatitnents of tbo nriiie^ 
cxpccially tho ore* and sal]>haric acid. (Parkcs on t'ni.f.) 



288 



ABSBXtC. 



AaatoiDy u BopnroUxl chiefly \>y tlio kidnejB; some, lioweT«r.J 
possea vriUi th« bile, and perhaps by the iateetinett. A portion ia i 
rvtAmed in the bod;. 



PEEPARATIONS OF ARSENIC. 

T>nY nrepnionit iwid prodncM no chnng<^e in tlw unlinikm skin, hot 
in vfouiida or flores it eimtea very ac4ive inflammation, with mucli|uiia, 
BRtHcicnt, if tlie njiplication in a Ntrong one, to dedrof tlto timies for 
some tlvplli. Araenioos acid has long boon tuod to deetroj irarts. 
con<lj*loniFit», i'Anc(Tn)UH growtba, tha norru of a ouioaa tootli, Ae. 

It omy Ixt applied pare, or mixed in rariable <]Oftat]tLea wttb soiii« 
bland powder, as Htiirvli. Ai timua thia application kna onjojed a 
liif^h repnt&tion, wbilHt nt othor tim«8 it baa fallon into alntoal ootn- 
plcto diKuse. Bomo have fallen viulima to this truetmeni, it is said. 
thr«agh the absc>ri>lji)n of arNtmic in sufficient qnantity to dMtny 
)ifi-, but an oDtoirard nsult like this can oocor only vrlicn certain 
well-known precantiona are diaroganled. Abaorption can be effocto- 
nllj pT«v«atod if snEBcient arsenic ia employed to oxoito actiTtt in* 
flosLniation ; for inflamed tiMuo lone* the powur of nlworption mon or 
leaa complotoly. I'rodoco actiro inflammation, and the patioat b 
mfo ; bnt if, tluxiiiKh fear of poinoning, too little arsenic is naad, 
that is tbo most eflidicions way of doing what it ia desired to avoid. 
Sni^goona experiimced in Uio employment of arsenio, reoommMu) 
tlwl, if tbo tiHocK to be deatroycd are oxt«nriYe, the arsenio ebtmid 
be applied to a part only of the surface at a time. Whoo employeil 
to rvmovu large growtlua like cancer, tli« akin being unbroken, in- 
cisions are first made, and into thcae the arsenioal paste is laid, which 
soon stirs np actire and deop-soatod inBammation, and the growth 
dies tor • conaidemble depth. The whole tumour ofton sloughs 
away from the healthy tissaes — is in fact rnucleatod— leaving k c1«ui 
and healthy aorv, which heals without trouble in flfteva to thirty 
daj-n. 

Lnpna and other obstinate ekiu affections may be trcatfld in the 
sanw way. 

Arsenious acid and powdered acacin, of c«oh an oowm, blendvd 
with five fluid drachms of water, form an arseuical muoilago maofa 
used by Doctor UnrGden lo remove opitlit;lic>uiatous gmwtha Somii 
of ihia urMmical mucilaj^ is to bo painted over the inmnur nigln 
and movning, gteat cars being teken to limit itit employment to tUn 
diaeaied Iimimb. £koh appUoaUon, covering not more than a Mjaara 



1 

I 

i 



AKSSKIC. 



289 



inch, ia to be soveml times ropOftt«il, rincl ttie wiparationof tbeBloaghs 
aided by iioulticiug. 

Tlie following pow<li>r may olsn Ira tuuil : — Frc«h lime, liatf no 
onncc; yellow sulphide of arBQaic. 20 (ifraiiis; staroh, 180 gnunH. 
Tbe nrsenic ehonlil conxtttute oiio>fiftk or ooc-sixth part of tlia 
aniODioal powder, bo as to insare the excitation of aufficieut inAiim- 
DiatiOD to prcvftnt poiwnoiiit iibitorptioii. TfaiH powdur inay be alfio 
(MiutioDMly UMd ns a depilatory. 

Liquor araenicatin paint«d over wiirU in mid to eanso them to dia- 
nppcar, and a limited exporienoo leads lue to bolievo that Iho arscnio 
doea appear to ilisintc^mtc tho wart, sn that pitoos of it drop off, or 
can bo piolccd out. If very ixrge it muat first be diuulved awity 
witb strong oitric acid, to nllow tho licinor arsmicaJia to come in 
contact with tho Hoftor tiflsiuea below. It lina npponred to me to bo 
aIko a useful application to corns. Tho com should be woll parod 
down and the liquor amcioicuUH applied tUrico daily. Tlii.'i tn-'atmeot 
1 have aeen ^jrently improvo oven bard corns on tbe sole of tho foot. 

An nrsooical hath i* lutefnl in •omo forms of rhonmntoid arthritis. 
It is made by adding to the vrator in an ordiuary general bath four 
otiDca* of common washing aoda and twenty grainH of anwuiuto of 
nda. 

Arsenic has a swootinh taato. In tooderate dosoa it appartmtly 
neither nndergoua nor praducaaany cliangoA in tlio month. Deiitists 
employ it as an oscharotic to destroy the exponod aoiiaitiye pnip of 
docBTcd twfth. or to destrny tho pnIp before stopping tho tooth. 
If nued to quell pain, the areenic may be mixed with opium; it 
sometimes at first nggrnvatc* tho pain. 

Wc seoi chiefly in children and oocaaionaUy in adnlts, a circular 
rash ou the tongue, which begins at a point, then ralarges, and 
KCparatir ringit may eoalesuc. Sometimes tiie edges am not raised, and 
tbe patch looks as if dno niorely to separation of epitholium, loafing 
the aurfaoe onduly dean and i^nouth ; in other cases tho edf^ea are 
raised, and have a gelatinous aspect. This affection is ofton very 
obstinate, frequently rvcnrring, and is gv<ncrally connected witli 
atomnch or intestinal disturbanoe ; eonio cases being always associ- 
uted with diarrhuMi. Other eases are nssoc-iated with a nsh over the 
body, like lichen urticatus. In this aflection of tho tongue, arsonia 
fans apjieared to mo to bo nscfnl. 

TliD vapour of arsenical ciganttos drawn into tbo Inngs is some- 
times usofnl to prevent or to lessen attacks of ofithma, and in scnte 
and cbronki ooiysa and chronic bronchitis. Tbpy may ho made by 
Ktanting paper with a solution containing fifteen grains of araenite 
I rtf pnfiali in an oonce of water. (Slilli^) 

I'heee cigarettes may bo n«ed in chronic phthisis. 

D 



290 



ABsmc. 



Anmic given in modicinnl dcmut is rerjr effective in Blongfatug of tlio 
tiKintli or ttiioat, malignant sorea, aA uuicmm om, maligiuiot tore 
throat, and the \ikt>. It is al«o saefnl in chronic (Mijzk. 

There are certain cvnoiui comj^ainta of the reatptnttorT tntci more 
or leM allied to aalhma. which I nil) non- refer ti^. In these oaaaa off 
qaMi>Mthiiia a dotie of unc. two, or three dropti of tho w>hitiQii of 
aiwntc three times a day oft«a proves eerviceaUe. 

I. A patient ik ncixed, peiliapa daily, or own scvcivl tines a daji 
gciunally in tho morning directly on rising or soon after, with an 
attack of peimt«nt nrnvxinH^. with pmfn»e ranning from the eyes 
and none, aecompanied wmctimcs with scvutv frontal headacbc 
Bach attack may last ttevcrul houra. Scvcra] days aometaiiMS elapiw 
bcf<ire tho recumnice of an attack, which is then usaaDy aevore, 
lanting twenty .four honrs, or evoa longer. The anaexing ix generally 
acooinpanied, and tometim^s prrccdod, by itching at a small spot 
situated iBsidi.- one or both nostril^ not far from the orifKe> bai in 
aome cases the itching affects tho whole of the inside and ontaide of 
the nose, extending even to the face- These attacks are excited by 
DxpONurv to cold, by dnsl, and soinctimea from nnaeccrtainablc 
cnnwcs. The disease may emdnre for yearn. 

II. We eocaeionally meet irith caaes, appuivntty identical with that 
jnct deacribcd, hiit with tliiit dilTcixince — ^che attack is excited by 
food, is most soTero after the larger meal, and huHm from twenty to 
forty minutes. One patient futt it«hing in the no§e, throat, and ear*, 
in distinctly periodit; moutlily nttiu^kH, worse in sammer. This 
attack was brought on by food, but a chill Mmetimes brooght va a 
paroxysm. 

IIL Arsenic is invaluable too in another more developed and 
•ereror form. Wo not ncldoni find » pstiont, prone to catch cold, 
attacked with severe itiid repeated tiiti of nm^Liiing, ac(!ompani«d wiih 
|>rofii«tt clear nncal discbarge, and severe frontal headache. Each 
attack, generally worse in the morning, lusts a few days; fant, owing 
to tho groat suscoptlbility to cold, it froqnently recurs. Seraro 
itching of tho ala of one or both niixti'ilK often forownms the patMUit 
of an approBching ntlack. A simple irritant like dost may ba ado- 
qnale to excite a paroxysm. Continuing in tliiii form for some time^ 
occasionally for years, the affection may then extend from the nose, 
along the throat, to tho longs, prodnoingsoro throat, fooh followed by 
mnch difllculty of bceatliing, great wheeling and free expectoration. 
The lung alTection may last for somu weeks. When this eerere fomt 
lias Imvumic* twlnblishcd, the Inngs may bo attacked without any pre. 
timinary afloctioti '4 the nnsu or Ibraal. 

IV. Again, uiuoag children, wc not uncommonly meet with a 
ir, nod pvrliap* idi-ntical, diac«m. A child, ]ierba[t| «ix tuontha 




ARSKIflO. 



291 



I 



I 



^wo.'udvPgoei a MTere attack of broncliitis, anti tlienoefarth becomes 
verj pTOUe to catch cold. Tlipn, on catching colil, lie is siibiDil with 
froquirnt und inovtoianl Huet^iiu^, loKtUif; ft vnriablo time, some- 
tiraeH a few lionrH, soniotimoB throo or four (Uys, and ruenlting in 
bronchitin, ncc»mpa.uied by much fevor, wheezing, and gr«at embar- 
raaament of breathing, sovorc onoogh stdii to oompe) tlio piititmt lo 
nit Tip in bed. The oorirsa ma^ Hometinua pi«o«de the cIyHiina>a three 
or four days, the sbortneM of breath continuing for many dayn, or 
even wDokH after the casBation of the oorysa. It i*. indeed, a form of 
ABthmn. The rhild cnconntom many altncks in th« y<?ar, c«(iccially 
daring the winter, luiil may continue liable to them for years, and 
then, porbaps, low them, or they may engender life-long nathzoa. 

V. Or we m«i;t with ca«u« like the following : — A patient Hnffers 
from aslhma for several years, and then is ecitctl with sorcrc attack* 
of HDcczing. Thcwo attnukis trlrangv to nay, may not vconr coinci- 
dsalty with the paroxyani of dyApnuA, the gneezing take* plooo in tha 
morniDg on riling, whilat tlio difficulty in brootlting ooinet on in th« 
afternoon, or at night. 

Those cnmn appear related on tlie one hand to bronchitio and 
dyspeptic aatbma, and on the other hand lo Lay fever. Th^ are 
allied to the bronchitic form of luthma, boing vxcitod l>y dti«t, cold, 
and direct irritants ; and to bronchitic asthma tbrongh those cases 
whnv the pamxymnnl ooryxa i« alwayn nccompiinicid by broncliiol 
aethmai and agsin, to bronchitic asthma, tbrongh those caee« com- 
mencing an [Htroxysmal corym, tlict diKvanc; extending and Incoming 
OonplJoated with bronchial asthma, or vice v«ni. To the peptic 
forms of aathmn this |>aroxyMnuil snccxing it related through those 
easM where the attook is eicitod by food; and those where the 
patient, a confirmed aHthroatic for many yoars, then bocomett afilict«d 
yi\\\\ ]iur»XfRmal coryita, induced by food, the asthma at last ceasing, 
the coryxa alone remaining. This typical case further illastrates the 
conaeotion between panwyamal aneaxiiig and dysjwptio asthma ; a 
child sinco six montha old is subject to attacks ooonrring every few 
months, most common in winter, liegimiing with not very scvcrft 
xncezing. hutting from a day to a week, often, but not invoriablyi 
followed by an attack of bronohitia, with much difficulty of brualhing, 
and fever. Even when ftvtt fTi>m nn attack the child, after a full 
meal, iw Iters from stuffy hmthing. 

Tti« foltoaiiic euu, oMuirlng Id Ik* conrw of four goMrstiao* ia tb« une funilj', 
ibow III* iollmklc conaoetUa twcvca Iht latirmiitinl uttdng mml a«lb<aa, for 
lafclni mu f«[loirt'l ia tb« frudtcin h; li^*MtbliM, and b« bfgot mi Mlliiniitic chllil, 
who mOtn (It 111* j«M mail (loia ftrvre attoclu of iteklofi and inociiiie. Dol doe t« 
pall«D, u VI* ih« tu* witb hilt titboT ; oao jatitnt (honing that ert^n haj^rthaa 
bk; bi IsflnMMd h; climate, vhilit bia ton «ii«ebltj> exen>|>lifivd tho Intimal* eoa- 

t 2 



292 



AKGEXIC. 



DMtion Wvvn iiit«rni<ctiTnl unimlng Kad uthcni, (or is hit fu* botb eo-«xltlMl, lal j 
bulb w»n pci>ll« in kinil, bciag eiv^h KntUf >nil nklnlr ioltucacod hj diet, aa-l In iKa j 
ou« of hU fxth«r kIu hj oliniKlf. 

Mr. [[.. >(«d 30. nio ennJUihor «m titlimBtia far jrovi, ili-iaii eloM apon 
jrnn d( *(«. Mr. H. l-imNlt tuffBrAil trom hty^utlimk from btbfbaoiL Tlia altaAi' 
OMiur mljr in tbc (iirins ilarini Ihe bt; tnusn. imi'I Imt «i verkiL It h* goca ImI* > 
h«j-l3Bl'}- "■'• oMr one, 111 ■• >itrl<!licn luimtJUtck triih > M>cn attack »f intaM* 
ilebisg at (he whol* iwlJc of ilia ao«r, *di| nl t)i* tntirt cnnjanotirk U boUi tjM 
(llitiigb not OTCT tbe fianial (intul. *nJ o( tb« ihroni, Bcoampuitd b; lioleot ■iiiMiiin.. 
and jnntuw di>cha.nD (ran tli« rfot sad oom. Hi* «]rn becom* blMdabot, aad llM 
IM> ivell MinctinKn la lucb kn cii«ni thit h« mn Kantlr ma Hu br^KtlilBg la my 
difficult, ind oithoni (ipvelonli'^. Ha inlrnirlf Ra»M|>libl« ii hr, thtt « llaM * fnal 
ditUucfl uir will iffiKt bim ; n>y, It bU cbllJicn f\»f In * ht^-liold, bikI iktn esou 
(niloon bo *i1l bare nn ■I'ack. IKbcr flo*on bciidra enm w na«*, Ac U tkia ti*« 



■ill brlog on s niiJil iitU(k. but ot no othsr lim* of th« jev. Sinaig ■unll^bt alas 
ibdiiraa tfatn unl'M i>'"to'l'''l bj liirgr dark-|lau>d apoelMlaa. .^lmi^/< ij Miy, li^t 
■cAi'<( Kiwrly offitlnl in Snuii, h-t itafiK (Wunfy, hi w faitt ^w (a TTi lin aiaiii, tn 
Sfatlaiid, and I'n /)(i»ni/itn', rirn (biiMgA (Ar srnm •< •■ /•>" Uoom. Tfcna, an om 
oocMton ■hen (iilTcri"); frnni a *st«r« attvlt, ba t'Kiied for Liolnn, in Ifonli D«*a«. 
and afivr laailnit IlAmiiiapla, b* 1>as&a to tnipi«T« mor* and moi*, and wliila u Uitaa 
ha vai qulta ine, ibouEb lb« hoiuc h« lind in vu eW l« a gttm 6M tn (nil bloatoa 
On 0D« ocrufriii, > faitit jubtinji in St. Ocsrgc't Cbaoabl, bat nM till llie (ouith 4tf 
from land, h« wu neiud with a aor^ta altaok. For tbe bat (our jfta, h« b«> IkbaU 
^ob^eaprajr thronxb bit noie iriib touktd bcnnAl. Hit aiiltr, Ivciilf-fonr j^utM, 
bu had hnj-uthink for ibn lui (our )(an. fiii foo. Aged t«n, bai ><iff?r«d (iotd mmn 
uthna aiuta a tiuirp attack of broo«hiUi obtn thrva joan old. Ha nuflen all iha 
fur ronud almaii vontiDBoaatjr from trtra lt«hlnc iuido tba ntw, in tkt wjvk 
thnal, oan. and uniltr th* ohin. Vb«n thcac q'niplomi ar* Bnni(al«d> be haa aa*«i* 
n««(in(, «>lb ralhor ln« diaoharfo o( clear floU (lem bi» Mae. An; kind at doM 
■Uiiuliii tbe ijrniptomi, bat cot opcdall/ pollan. So aaflei* alM (ran wlianhii. 
Md when Ibt itcbioG and nieninc are tfgnnUi, trom mtioh dilScntl7o( brMlklOf Ml 
flolant eaa(h. 

JO iktt tympttmi an wry grtaSif liylwiuaf Igfati, Ibsi, tbe ileUoff. Aa, Md 
Ih* iljitjoma, *M alvafi ncfniraUd bjr pMlrii xvMUh ud opMiaUj by a bna*; moI 
tah«a In the anntoK or lata at niibL H« bH bwii niach cone rinna •> altark of IW 
mualw tbr«e nionlba t^, and inbaoqucntlT ui> fooJ. trrn bnad and butter, Inrriani 
bath the itobiuK and the dilSooltir o( hrtalbiDc. lie dota not eastl; <kl«h oaM at 
BrigbUn, nherv be U ftlov* '"■ t'"*" ■'' bii iroubiM, and on one niil to liatSB ha 
loat all U* (jmptomi dorinii hi* aaJMrn Ibert. Ei* aloiuch baa Ut«]j bsaa ««x 
d«ll«Btai n that ha tobIu f«iT readDf, Be ia rerjr dat-obedod aod nond^boitlikn^ 
be abofiaa loudty, and hb uplration ia M17 paatl; pntonitd. 



The follovring intwHting knd iDfltmotJTD funilj history ihruwa 
much light i>ii the nlBnilies of thatw cariotiB ooTDplafnta. A wonuui, 
when yooug, euffi.'rt«t fnmi bn^itcliinl asthma, trlitch loft her for soot 
yekTi, mmI th«n abe bocaiuo ftffocU-d with tuy.oxthniB. Sho bora two 
MOQii. One, affod t)tn«t««n, hu mfFervd for Iwo yea.n ororj- raorDiait 
duriitf; the tramnior from viulent attMlui of KDOcztii);, and pruftiM> 
waterj' diachorge. Tlutso attacks oro not excited bj* bay nor the amvU 
of fluwera. 

Another mn, itir^ ihlrtr. hna lieen mbjeot to uthiB* Mntl \mm^ 



I 



• 



AILbBXIO. 



2y3 



t^Ha Ainca live jean of Age- It bcptm, aikI for a long limo 

'mntiiitwd. of the Bftme ctumMtor as tLal so often seen in the com- 

menosment of natbma, esprcinlly in jountr rhildnm, beginning l>y ao 

nttoGk of cold in (L0 lioaO, vriUi ferer, tabling aboat three d&jB, 

followed bjr abonl nine dnj's of iistJiniA. (Sec Aconito.) 

Tha bronchial MlbmR of iIit mutlior no* mail Hvvrc in lli« wlaUr. Kroin llilt iho 
qolte )MOT«nd, kud icmunod irtJI foi ecvcnl jeu> ; but dnrlog tbo lut Ua f«ui 
riis hM •oAarvd from woU-morkBil liitj-utliuu, tbs nttaelu bein; ftppareDilf ■olct; doe 
t<i btr- 

lli>r mo. aged 19, for tiro jti.n hu millcniil /rom •lolcnl itUcka of ■ncning inJ 
mui^h mnDiiiK tram lbs dok, iho parutpm laatiDK loiDetiiDei (or boon. Tht^ ikr« 
JWi^Oni pacicnl bj mocb itcbihf ot thi wlialtf iiihkilo of thu untO- Tli^r^ in tio dffpQ'ja or 
whoctlng. Tbcw atuicki ocour chieB; in Ihe morDini^. iliiKtly bn icU op, bcit the; 
luu; Kiie him nt an; hnur of the ilnj. Ue run go inu> a hijCcM, nr (ucU jlowott, 
without proilnciiiH ibn illnliltuil trici ot an KltMk. Tbo; are hrniifhl od bj doit •Dd 
•ttong auullght ; tbcas being Itin onl; oaura he bu [toltclcU, but h« nannol aronDDl 
tor IboH ntluka lirgiotiiog direoti; ha K«ti nut of Ixd. Tbs oaiii|i)aiDl IniU tbs whale 
tnmnier, Ifiving brni In tbo wtntcr. Tho alUckt ari nut aSvclcd b; food. 

Ilia bralbtr, aged 30. bu luScred from brooeliitli and lailimt iIom Gte jfMS 
old. At flnt the altaoki br^aa wilb cold in the bead and terer, vltboot iqanh 
(nmiait. Thi*M*G« laaud ■boat Ihtt« dsji^ wb<n bin Ibroai becKme ilightlr lorv, and 
Dal broQCbltla wt in. To uie hii own woidi, be hat (tneiallji ibiix daji' fold in lh« 
btad, and nln« d>)>' utbnia, though lonetilne* Ibe aitbma liutod maeh lonKir, 
indeol, MmeliniM onnllnaing foe mantb*. Ai ha hu i^ntra older, Ibe uttacki haTO 
uiidrtgoni oenalderable modiGoation. Tlia cbot tjuu'lomi I'Cfin with 1 cold in the 
bead, or Piaj o<ciir without it. H« ii obliged to lake ibo gteaiot cara, toe ibo ehill 
bring! OD aD aitoek. Stnngo to aaj, MDditiona which at one tine iDduot an atUrk 
ara {ooptnUve al anstbor. Thoa, ha caD HnetlmN join a ba; pait; wiiboat beins 
alTocteil, fot at i>thet timta, so'ng into a aUblo, or piuiing a bay-eait, not Ut montion 
going into a bnjr-GcId, biiof* on a tiotent attack. Dmi, u beuM dvul. bulldar*' diul, 
euitc an auack ; m doca iti^iog (nntlght or dowetii An aitiuk induced b; tnj ot 
Iheai ■iceaUt, mntUta in itching of the noae, nolonl aneeting, witb |in>(ii<w iliicbarga 
troDi t<r«* and near, lb* tWhin;f and diHhamo l>«ias nianllj nioil mukod in Ibo ktt 
no«MI, tboogb •ODOtJDiM lll« right nutril \t implicated, hi uMitioo, be luffer* (Tom 
djtpDon. Th« «ni7ul »ympUinM alwaja eoeur in Lb* dnf, tbo dji|iDin at night. 
Vbon IronbleJ «itb aalbna. Ilia drqmn* >> conaideraU; aggraTAUil b; food, vhieh, 
IioHottr, alanj olhfr tini) doaa not product anj tifhioua of llie braath. 

StroBii blaek coffee, tnn tha nnell of It, Immedlatcijr kIictm tbe djipn^n, but ia 
without otbet CD hia oorju. 

Tha fnnei from Himmil'* powd»r voDdarfaUx relier* both llie aoiTia and djajmoea. 
All Inhal>tlo^^ wilb Uie (oitgoing eicopiion, "il|bt«a hiu Up artajwhet*, ares in 
Lla soK and Ihmat." 



ir 

Iliraii 
pnrti 
time 



In lomo CMM sneezing, with ita eoini>1ic(itionii. Appears to bo 
limited to the nasal part of tbe fifth nvrvc, or even to a verj- limited 
portion of it. In otber CMea, after oontiuoing in tJiis form for somo 
time, till? tliniAt l>rtiticlu.'S of tho fifth may bocomo involved, and 
SubMqiieiiUjr the vai^aa; or vice tend, beginning at the vagns, it 
involve tho fifth ; and in either c&ae Uic diacoae amy c^nit tbw 
DOnre origiaallj afFeot«d, an inoidont ii)o«t common when the attack 



2M 



ABBIXIO. 



fint oiFects tiw fifth norro. Indeed, in my experience, tJiia is not 
ail nDtiatuU way far tisthma to befpn in cliildren ; iind iw the/ grow 
up, the corpnl Kjmptomit ooaw, and ordinaiT* brondiitio sslbioft 
alone remaina. 

On thp other liand. these cases of paroxysmal coiTia aro rel&ti>d 
to hay-aatlima, wliicli, indeed, appears to Im) tho soma diaowe, bat, 
owing to tho patient's idiosynci'as}', the attack is indaoed onlj by 
the polk'R of ]>lttuttt ; llii> Kiniilnritjr hptwoen tbciw uSectionit bcdag 
shown by tbc fact, tliat in each tho luincliief niay be limiled to tbe 
now, fronts] sinuHca, and eij-c*, or ntcnding farther, may involro tlw 
Inngn. 

Ur. Blocklcy, in an admirable paper, shows, that in his own case, 
and in some other inatatioea, haj-iutthina iii Holely due to thn irritant 
4-(recl« of tho pollen of plants. Mo conducted an extensiro seri<<>a uf 
cxporimenta with the pollen of manj- gTHSKKx, cenalH, &c., nnd found 
that all are capable of exciting an attack, although some kinila of 
pollen ara more active than olheni. Thii pollen of poieoiionit plants 
is n<it maT<! rinili-nt thnn thai of liarmleas plants ; indeed, he (Inda 
that pollen of eolanaceons plants will excite a nlight 6t, wbila tbo 
pollen of wkmt excites a very aercro attack. In bia own p«non, 
and some other cases, be clearly shows that oil tho agenta hi&lierta 
snppoaed to bo Nevvrally productive of aatliina, as osonCi heai, stroog 
BBnlight. the volatile principlo on which the odour of ploata dvpvudat 
oleo-reaina, dnst, anleas it contains pollen, ar« powerieaa to praduoa 
a paroxysm. In other cnsea, it appears that one or moro Iciadt of 
pollen only will produce tb« attack. Tliu^ roae-polleD excitM the 
attack only in eomo patients ; and it is Niid thnt in America, BoinaB 
wormwood la * frequent canno. Hay-n»thnia oikI tlie disonaos just 
described are indeed idcutioal. but owing to individnul idioaynoraayi 
tho attack is induct^ in one p<>rKon by one irritaat> and in »Bir1hT 
by a different irritant. In aome oaace, the attack, as we havo awn, 
is induped by pollen, in other cases, by ipeeaonanha, or l^y animal 
emanations, aa from luhbita, cats, borscs, the smoU of muatard, 
feathers, or a privet bodge, Ac. Dr. W, Smith, of Pre&ton, narratca 
n case in which a linaeivd poultice provoked (he symptoma of liay- 
asthma. Simple dust will occnsionnlly excite tbcsa syntpumia, and 
•ometimca one kind of dnnt uidy. I'Iiuh, a middle-agod iiinii, an 
inmraon^r, had snflcred from paroxysmal coryira and natluna for 
two years, tlie attacks being brought on oidy by the dust of his 
shop; whilst otl>er kinds of dnst, as that of a road, failed to affect 
hiu; iMw did 6ower*i. giaasoB, iui., nor snnlight. Thia oa»i< was 
•ingitlar in thia raspcct, thai whilst only the dust of his afaofi oxcited 
ooryia and aatitma, yut in certain looalitica ho sufTered at night from 
simple asthma without coryia. Notwithstanding Mr. Blodtlajr'a 



\ 



1 



ABESMO. 



a9s 



nmfnl and clitborat<< oxperimimts, T Mnnol lu-lp bcliuviiix tbnl cun- 
liglit nni] <n%iit beat will in some persons bring on an nttnck without 
the int4.T\'cnti(>n of pollvn. It is woll knnvm, of oonrto, llutt iitroa^ 
Bunligbl nod great heat wU] inuoli Bggra\'ate the attack indnoed hj 
pollen. 

Tbo ilohing ami liiii;Hii|^ nliich fucnerally acoomptmy [Hirux^Kmnl 
snoMting, no inatlor trhnt ihoir exciting cniuo, may aSect tho whole 
or laij purt of the uohr. Somotiniea the tingling and itching aro 
felt near the orificet or in§ide nnder tho hridg«.', and may extend to 
the ulicuk or t» the ejoa, now and thi'ii only to the innor cuttlitu, 
and may bo limited to this part, or they may nSoct also the palat« 
or throut. I rcinumbL-r the rorrxa in one coae wiw aconmpnniod and 
probably excited by itching of the nose and soft palato, and that 
iodins inhalationn at once roraoved tlie ooryza and niiaiil itcliing, but 
left imftBected the itching of the palate, which ceased at onoe on the 
Application of a little nitmto of eilvvr. 

It ifl interesting to observe the very difEerent degrees of derolop- 
mont of tho (linoiMc. Tn cnrtain caBot> the attack in noiav UMods 
appears to be limited to paroxysmal severe itching of the inner 
Gtuithos. In »tJi«r cnitini, «\-cn of truu "liay fever," tho irritant 
excites only this itching of tho inner canthna ; thoagh at other ttmee 
it also csoites paroxysmal Nnoci^ing ; or tho attnck may at Grst ho 
limited to tho itching, but as it goes on, sueeEiug and profuse 
watory discliarge are Hnpuroddod. la othor instiLnoci, bo»idM tho 
itching and sneestog, tlie patient suffers from bronchitis and 
dyspncra. In another group of cases the irritant only oxoites bran- 
abitiN and dyspncea. In yet another set of cases, a paticut bat 
▼tolent attacks of sneeung, generally occnrring in tho morning 
without any itching ; and In one inHtance, a lady bad each morning 
profus watery discharge literally rnnning from he nose, lasting 
halt an hour, withont itching or ■naestng, this discharge atn-ays 
ceasmg immediately her bowels were relieved. This itching gonomlly 
yields to iodine inhalation, ovon when it fails to anett the {lai-oxynnial 
sneosing. 

This affeelioa nay bo likonod to nonrslgiii of the branches of tho 
Rfth, supplying the inside of lite none, but insteaul of pain, there in 
intense tingling or itching, which inducot violent sneuxing and pro- 
fuse discharge. As in the case of a neuralgia, wo can imagine the 
offootion in qunttion to depend on (1) an excitable coudttiou of tliu 
termination of tlie nerve ; (2) of ito trunk ; or {H) of port of its 
centiw. In the first category, a normal elimntation produces a very 
powerful elfeot on the terminations o[ the nerve ; in tho second, a 
uatnrnl impression beoomea intonsifiod in its passage along the 
ner^'e; in tho third, it beoomea intensiSed on reaLrhing the excitable 



ssm 



ARSS^IC. 



nucleus (sco rcmftrkR nn ncnral^a in Bectian treating on coiiuter- 
irrita^n), and the resnltini; nrgent tingling tndnccH (tnooKitig Mid 
the aocompnnying phenonicnu. It in aUo conceivable, tliai itt 
certain casee the fault lira in tho contm for unocaing, tliis boing in 
»n oxcitftblo statv, ko that n nornutl stimulalion of tbe nasal limnchi 
of the fifth, induces rioloot mecning. It is oftvn diflicuU to docide 
whcro the fanlt lieti, whetlier in the termination of the fiftli, i(« 
tronk, or ita nnclens, or in tho coDtrc for fmoesing. Wlion Uie 
attack is provoked by jmiIIcii, <lnst, tunuko, animal emunationH. or iba 
amdl of a liuaeed ponltice, it is imposeible to locolisD tJie scat o( tbs 
dinaae, bnt scimolimos this niuKt hu in thu central nerrooa nytlem 
itself, OS the following case illuBtiates : — 



Un. U., tA. 32, bu anfftml fram attiKki cj mMiinR Tar tbiM jcin. 
■tUek* octal M iaUinx\» M iho jMr TOan't. but »rc wonn in viaUr, tad nn br 
on ohMflj bj mill xh or dnuijht. l>iiiicilf tbit gvit nut of bed, whcibsr ia iUt i 
o( Ifae olgbt ut In tbi niorning, Ihco od come* tbc ilUfk uiil UH* two or three 
The Ickrt dnofiht n-ilJ briuu it on >l niijr time of tho <Uj, Du*t or nnok* uhIdsm Mi 
Btu<^k. and tht doiii, on iwctping hiir ruoip, brjagt on k Tlolnit At. Slron^ •aaliffat, 
or oarUln Howtm, a* llllei. ioduoo > mildor klliick, toij' iligbt coniputd t4 on* Mund 
bjr duit. EudUmcnt, fati^no, or tmnj bringi on %o i'Uik. Tbo oieaias U t*I7 
violent, ■ml tliooiit iacManl ; Ibo diiob*r||« fiom tb« aoM, chioRj (ram the rifbt 
noatril, U profon, Mtd bet ofn ras cuplou*)]'. Th« tttaek U *l*aji •ooiBt'MiM bj 
ininue "tioklins" of Iho ohaie inaidoof hot note, nnEh mon mtotc ia tbc rifbt 
noMril, and al**;* eomniaMiiii an tliat aide. Tbo itobinc ulfnil* lo tbo Uimt jitrt tt 
ber ef«t, bnt u not (tit in tlio cjoIldiL 8b* bu tho aiiiio liokling, bal itishlwr, mi Ilia 
rittbl Bids of tbo taooes, and cximding to tbo right otr, «!lb » MBwtlon of «old «nt«r 
Id tbo far. DuHdk an alUck the hM a lenBitlaa «( ccmitiiotioD, but only oa tbo 
rtitht Kido of 111* ebwL braahiog or oombini;, or palling out a bair jnu abn* Iha 
rijbl frontal emlneaoe, or etptclallj picking a jiiniiilc on tho portion of iba tombaad 
jast Iclow tbii, hrinp on " a dtcadAU ptiikin;; Mnialion," cxicndiog DT«r aa ant 
about Iro uicboi in diamatcr, inTolT{n| iba right tide of the forthead and lb« afJjMnl 
Malp, OB vhLoh tbo balr b galling gny. Thii jirlcking ortt tbo arta alvaya bri^n oa 
a KTor* altask «l nocoing, *itb all the ooooaoiltant urmplonii. Oa the oLbar l«ail, 
aiaMki indnnd bj nnoka or da«t aln prodaoa thti prirking untalion ia Lba (orahaad, 
bat to a Icaadtgm:. tiiglil. bearing, anil (■>(• art uualltv-Uil. Thnrv it ■omo pcafoiUeUs 
in btv iUatai ; Ihni, for two or Ihrccireok* ihs wlU be WlUr, and wUl than roIaiMh 
Tbaro b ao bomliUrr tcodmaj lo asj ntiirori*, and no inilantc «f aaUma ia li«r 
(anUf. 

A atroDg mental toprMon will amM tbo atlaok, u a fHgbt abont bar ekdilrva. 
Tbo fanijan* ara aot voras dnrlnc tba niBOittaal pcriol. Oaring jrapManj thu b 
(foHa artU, opceiallj alUr qiiScVtiiinir, ■baa tlie untt inuob ainngar. kit, atln 
■neUioc, aho ruj Moa fccoMoaa wak, and tkcn the allae^ ralara. Tbaj ara bb« 
ladaaatad bj food. 

Oaoa «b(« U Drighlon tor • v««k «ha wit antirelj Irca from ittadki^ Ihaagli Mtijaal 
lo Umu Df to Dm titaa «( going tboro, and Ibry ntataad lamtdiaUl;' ihe eaiaa horn*. 

Doting h*r lait prrgnanej ll,c mcaing, m unual, left hfr till t^ oa^ht * e«U. 
aWn tbo irilution «u Ilmilvd l« tbo loft noitht, aed inner cantbai at Ml tj% "f^ 
darla( tho iltacki of mtot* anonlng aba bad a diMlkaigB oel; from Uk loti noalrU. 

In Hrs. a.'t cane tho irritatimi of a spot near tho right frontal 



eminence tspplicd bf bnuiclieii o{ tlie fiftli, prodoeed a violent attack 
of Hneoiing, laating soveral honrp, with priuking pain orcr tho Mjmt 
itself; aluo througbont the in!ii<Ie of tho dobo, imd the H(;kt side of 
her throat. Thns, tho irritation prodacm an ubn»nnftl BoniMitioD in 
a limited nninbitr of the gnpra- orbital branobtt^ of the riffbt Sftb 
nCTvee, and thi§ abuonuat Bctneation, inrolving niolecalnr cUangcs in 
tho onolena connected with tUeao iwrrca, spreads Uirough that part of 
tho nnoleiu in coonoction with the nerves sapplyiag tbe mocona 
membrane o( the nose and throat, ^'ives n&e to a Hosation of 
pricking in the nose — a rofm-rcd eonsatiou — which phy Biological Ijr 
excites vio!ent xnoexing, with ita uuturul acconi[>animent — discharge 
of tears and mncus from the noso ; further, this molocular chnngn 
ejctendji to the pnenmogaMtriu nuctonn of (he right side, and lience 
excites some dtfflcnlty of breathing, and wheeling on the right sido 
of the cheat. 

Again, in Lkoaa curious caaes where the itching and sneeiing are 
oaused or incrcoaod hy food, we maat a«lmtt that tho affection is 
central. In rach c«8e« we must aasume that an impreawon con- 
veyed from the stomach through the vagus, and reaching ita centre, 
will, through diminiahud reeistaDce in thin part of the central nervous 
Kyntfra, spread from thence to that paK uf tlie fifth nnclctw in con- 
nection with tiie nervcH proctieding from the murous membrane of 
tho noM, indocing in thix part of tho norvons centro these molecular 
changes which imprewi on the ncnHOnum the hgumiUoii of tingling or 
pricking, and this condition of the nervous centre of tho, fifth excites 
phj'siologii^jtlly violent unuexing. 

In other cases, as 1 have said, the fault is probablj dne to an 
exuitable condition of the oaotre for snecxing, a« when tho tingling 
or itching is limited to a very small spot, and is at first sight far too 
slight, both in extont and iutvnntf , to produce that violent «ni>oxing 
which nccomponiM this tingling. Wo must admit, too, I think, that 
in those cases of seven morning sneexing, aocoinpanying attacks of 
bronohial anthma, but wilhont anj itching, as cxrniplifiod in the 
following case, the disorder is, iu part, sttnat«d in tho contra for 
sneesing. In raoh a cose one would think tho ivthitia muKt Iw 
central, and dependent on an exoitabte condition of tho pnenmogaslric 
ceuln' in connection with the lungs, and that through loss of roiat- 
ance the nervous dischargo in this centre would spread to tho centro 
for snoecing; hut UiIh view is, 1 think, unt«nable in thoKO vjuum 
where tlie attack of sueexing doea not uccur during the parpxj-sm of 
aathmn. that is, when the nervona discharge is greateet in tho pnen- 
mogUHtric centre, bnt at some other time. 

A JDBn|{ vomsB, MthmsUe fcr rifbt yttn, tbevgb oel/ in ir>fil«r, en eatcbiog a 
Mid, whvD *li« niftn troiu * Tlolanl utftk UMini Ihrts ot (our itj; groTing lew on 



298 ARSKKIC 

tie CMoneDM of fipMtaratian. Vboa wlbmtlir, I««d «f rdj kind ti^tens Int 
brMUiiBg, N tbal during tbaie ilnjri the Ukw no fooil. Wbilit undef Uw KUMda (ka 
likt piraxjimx of hhumIdk ctuij murainf, vithaul du«I llicliing or lIactiB| ; vh«B I 
Itom ftjilltiQiL ibfl hu DO loccjipg. vid can e«t •njtZiiag vithoat Affecting khcr i 

Thii twc ihom the cicve nUtiouiliip bttown both broudiiAl luiil peptJo aaUuna j 
Uitu MUok* of iDfexiag. 

Again, in somo comw, tfao nffoction would awm to be soaUN) in that 
part of th« centntl Derrouft BjBtom wlucli controls Iho fomiHliun of 
maou in tbo noso, as in the instance of tha huiy ulroady inferred to, 
who, evmy morning to HufTcrcil for Kbout half an hour from m 
profnsD watery <Iischarg« from the uostrils, without uij nanU itefaioff 
or aneexing. 

Tho case I nni about t*i normto shows tho oonncction bet««ea 
iiit«rm)tt«Qt snoonng nod afitbma. Thin patieot for aonw yum 
SoBcred itatu aovero int«rmittcnt iineesioff, vhioh thm bMsine ooib- 
plicated with aatfamo, the aslhina meanwhile increaang, whilst the 
Rnrcxing gruw Un nnUi Ims, till it nlmoxt censed. Tho Mthma w«a 
peptic in kind, aud nnnssociat^d with bTonnliitis. Bed-diut wontd 
alwajm induoo dcvcm attacks of sDOCKing, and subsequently of uttbiBa. 
Now, as bod-dost is quite insolable, it wonld appiMir that the part 
affected was either tho nrncous mofabmne, or the terminationM of the 
n«rTe«, first of the muoona membrano of tho nose, next of t ho longa, 
whilst thu change of tho disease, from intermittent snccxinR to woU- 
marked peptic aathraa, favours th« idea that thu affoction wu 
sitnaled in the nerroaa centns; possibly both thenerre tenntnationa 
the norrc cc-ntrcfl wore nlfcot«d. 



lb. B., abent 3S yt*n old, ch«nii^ hu b*ca ill Imln jmn. 

At Sal h« toDtrtd fTom Kllaoki of rawslng. with frefun «»l«rr <ilNhai|* tra« 
the aoMt MCtoniNaMd I17 to; illiliwlin and intciue ilchin^ am a RUall «|rat oa ih« 
innn nirfaaa oT «ach ala ot tiM Dg*« near iu oriAco. tbmt vu no ikliln|[ of iha 
BOM bcjouJ ibo nyou inilicaUil, Dor irt U>* •;«•. nor fanon^ bat lh« toft palata (alt 
" rMi|b." Tbo atluki al^v* <McurT«d in Iba morDini;. not on 6nt rUa(, bat aboM 
niar, and laMod till *Le<^n. □« nniall^ attribnlcl llieir odmI to wpgaaw ta twU, 
it* nmotiDMB n^ad four, nioallj thm pocktl hundkrRhLefi, vlth Iho lainj aMal 
diKbarga. Bu ojci Jarinit tin atUeki oen noeh bImilthaL Thef oeoanaJ ai uv 
lioia at the jtu, tboojlg man fnttuanllj doriog ipriiig uul autunia. 

B>d.4nit alvaja hnracbt on a ntj atren attack. Duit o( absp alao rrnltart a 
[i«mx7«in, but not otbar klndi of dukt, aa lood daat. Smako did doI alTaot htia, aw 
hajr-fiolda, for be baa eftcn f»iiii1 ihcm «hila tba fcnua vu fiowtring ■ithoal lavantaf 
•a attack ; a) wUh «*ber Sovan. Itailhor ttrans i>BnU:ihi nor ativn^ haat tnJawJ ■■ 
■Ua«k, nor IpreaenaDha, nor animal «n»Daikoni, nor liuead poaltiMa The aMaeks 
vara not *xdl«d iLrDOgh tba alomMh, loc L« tni^ll tat what be likfd a* aoy Uaa 
■ilbaal brintlBg as •ooesnci IbooRh bdere tbia illoen li« notiead that a faw oali, ur a 
■Ian ol «btn7. voald caaaa a pMoliar, ImleKrilaUo (cnaatioa of the ah««l, leadlBf 
bfaa to late <kcp brratbo. Ha atiatki of nnawlng vtre eo liolcnt Ibat be Itan4 la 
AmM ' ' bant aaoie inlanal rcael, " anil (baj Utt b^ eikualed. Darin( (fee 1 



AESKXtC. 



29!J 



ho butl no iljtpna.-(L. Au^uiC liuti whilit mixing chiLlk, oni* root anJ mjrrb, tbo 
liowdcr brODght on » tsrvre iltaok. 

Aboat Atb jetn ago & ainiuUr phanj^ cima Dvsr bli IIImml Qo bMUne ntb«r 
luUiidatiM], uid u the uttmift bconie more |>ront)UDc»l, tho lOfciiDE nllacJU fmr low 
till tb*T bftT« all but ]a(t bim. There wu a period wb«D h« iru Uuubled liotb vllh 
futhmi and iDeuiog, hat lh*j did Del ouur olmnltkneoujilir ; tDdecU, vitboat %aj 
qoeeliai, he utld the eoe took tbo plaoo at ihc other ; for il be hnd m atlaek of 
uthiM b* koeir ho ebanld not hue the soceiiiig, or if he hod in altaoli of KDoming, 
he felt iDmnd «^iut uUiuul Tlio uttbrnaU'e tttuk bettias U, i «.h., and liuli t»o 
houn, MmotlmeH eDiUnc with » tew outbumM at inening^ bat aeret a paroxjon 
eonpiirvd to bli earlier iltockt, or Ihon alternallDg «ilh uthmn. Qii ulhma U 
mnjnlr o( Uie peptic « haracler, and la inoritaMjr broiii:ht on !•; a lalo, and tspoeiallj by 
an iodigdllbl* Dieal. 

Ucd'diut formerlj eieilod tbo ulbmatio paroiT'iii immediatd;. Cold woatbor doci 
not cauM Ibe aitbioa, nor tot, i"^ ^''^'^ "''''° ^* i*^ ^ NTCn oalonh. Oolj lat« 
mull eicito the attack, k doM of eolebionm aUajii cauin u attack, but not till tho 
third pightlf doan. oo^nrting "on getting into bed, nnd tor an hour jmt before iliiDg," 
M> loD| 0* the colchiuQm ia eontiaued. Tbi* elliMt of ealuliioorn bo baa ootind an tbiM 
»epaialo oeoMdoni ; as be nerer bail occaaion to take wlEhieam dnriof lbs (DMtIng 
period It U tni{>ofaibl« to **y whellier tt vonld havo produool * paroxjnm. [pcea- 
oeanha briDgi on a Terj t1!(;kl ipaiinoJia aenntion in the threat. Spreading a piKh 
plaitir *ill alwofa bring on la atta<:k, hal nevtr induiri.'i no attack of unenini:. Th« 
aithiunllc jaroijim eotb ia protoN •zpaotorition, wiili a tioUiil Aeuih anJ profttto 
penpiniioa, poralhlf do* to tbo eoagh. Daring an aithmatle atUck be eiperionoa no 
ilebinc under the ehin, nor onr the ubeat. not IttwMn the iboulden. HU grandfather 
had uUinia, bet there i* no biitor; of iay farer lu bki Taiiiilj. and liia ebildien on freo 
fnni both cDraplalnt*. Artenlc doea biiu good. Strong ooOeo relierM hit altoeka ; to 
dota nitre paper for a time. 

Anumic in maoy of tfaeso cases is mont officiicioas, quickly affonl- 
ing relief in some, bat in otbeni requiring t«D dajii or n fortnight to 
muiifeei it« remedi*] effeot, whiln in yet othur msoa it nltoR^tlier 
fails. I lincl it of littlo i»r no value in true haj- fuver, thitt i*, whore 
the paroxjnima] aueexing is oxcitdd by pollen. Where there is fever, 
nccnito (seo Aconitu), if givcna Mrly, curtiuls the conrm of tlui ittlAck 
conajdi-mbty. Cmm tmyielding to (tncuic are aometinue benefited 
by iodine inhnintton, fay tlie hdministrntioa of iodide of potaasinn, 
or by renttrura viride. The cam of a young woman, twenty-two 
yean of ago, who for sareml yoors had sofFered with attacks of 
Bneexing tike tltoAo deaoribed, well tUuKtratoi th» thIuo of local 
applicaiJoDi. The fit* oeoarred in tbo inomin;;, lasted sorontl hours, 
wem aocomponiod by ooncidoisblo pnin ot-^ tho forchcnd, and the 
sn«exing was so violent tliat she bocaine quite exhausted, and to 
remitincd tlio groatvr part of tJie day. Sbo oomplaiood also of 
great itching over the whole of the inaide ftnd oatside of tho now 
nnd ptrt of tlio &lce, which continnod lut long bn tliv sneezing. Her 
health was failing her, and ber hair was growing very thin. Anwnio 
)KiiDfit«d hor V017 dightly, while iodioo tnlialntions, tlie internal 
administration of Tflratrum Tiride, pnlaatills, iodide of potnsfiium. 



300 



ASSBStO. 



bromide of potaasinin, and codOivOT oil w«ra fotind ne«laas. Then 
anoDite liniiDiMit to the ouUido of tlio homo ftnd itching pnrt of Um 
Akoo, immeduttelf auMued the attack, removinf- buth tlie itoliiii); »nd 
the saemiag. Tho attacks of §Qooxtng rocanv-d very aligUtly, and 
tt fortnigbt'H poritialeuL-u wltii thu treutTiiL'Qt cared them. 

Tho changes which itrsonicnl compouada undoi^ in tbo Gtotuacb 
arcntprettcnt unknown. There iit no [iroof that, like mo«t oUivr 
motAls, nreonic combines with tvlbnmon to form an albuntinftt«. Thu 
uni(»rmitv uf autioti of all Holuble »rii>6nioal oompoundit readers it 
probablo that oithor in the Bboniach or the blood, they nltiniatol/ 
bcoome ideatiual in comjHMtitioD. 

Metallic arsenic, ]ike the oxide, is poiaonons; it ia probably dm 
oxidixnd before it bccotneH nctivc. Pure ealphidi' of tbo mutal ia 
inert, but, as it generally cuntruun a not iucoDHidvmbte tjnnntity of 
tho oxidO) this admixtaro renders it poieonona. 

The oondition of the atomnob in naid to control the Mtion 
arsenic; for example, when food is prenont, the medicine ' 
alMorlwd by tho lacteal*, and through thmn niixinl with tho blood, 
while if tho stomach is empty, the arsenic ia absorbed by the vein*, 
ondt paasing ioto the liver, ia wpamtod with the UW 

In Binallt medicinal doses, arsenic excites n aenwition of wnrmUi 
at the epigMtrium, and g^ivea rise to a ecnantioii of hiin^r ; indeed 
many maintain that arsenic, while inoieosin); appetite, promotes 
digestion, which othcra a* Htrcnaously deny. Arvenic, ax wo ahall aev 
hereafter, by remoring or leaaeattnf;: a morbid oondition of Uw 
atomooh, promotes d^ostion and appniite. 

In certain diaeosee of the stomach few remedies are more twofnl 
tlion arsenic. In the so-called irritative ilyNpcpsia, where tbo toutfn" 
ia farred, »a4 its jinpillw red and prominent, a drop of the mliitinii 
of arwnic, token ahortly before food, will l>o fonnd of groat bom-ltt. 
Adminiatered ia the same manner, il will arrest the dintrouing 
vomiting of drankanU with almost unfailing certainty, and 
simnltanuanily impmre the stale of the stomach, and rMtonv liuth 
appetite and dit>eBtiun. This vomiting, accompanied by groat atrnin- 
iiig and dintrcHii, nmudly ocount in the momiut; licfore bnokfoet : 
itnd mostly very little, and sometimca nothing, is ejix-lc<), and then il 
ia oalled diy vomiting. Tbo vomit is genuntlly inlensly biltor, sour, 
and of a green colour. 

Araonio is valuable in ('lironic uh'er and caneer of the ototiMek, 
•Uayiog the pain and checking the vomiting; and I Imvo seen tkU 
metal give relief in ehronic ulcer, aflitr faitnre of tlie comwonly- 
Used lemedlcs. It ia eometimee naef ul in the vomiting of pregaanoy. 

Anwnic sometimes remove* heartbnru, and otiier distroorinK 
aeasat4ona of the stomach, and is very nseful in gaatimlgia. 



ASSENIC. 



301 



P 



Smftll <lo»tti of tiraenio nni Horviccabic Jn tlint form nf chronic 
Tomitiuff, when, after eating, tbo patient mostly rejectti Mh meal 
witltont pnin, nnd with Kcn.rci;!;' <U),V nauneo, tbo food aimply rcgni-' 
gitating into the moutb. 

It liuH bct^ti r<;coininoi)dpd in the vomitin;; of cbolrni. 

Tbe aolntion of arsenic is always of service in that form of obronii; 
dyspcpsiii and dinrrhooi. chftmctflrixod by the following Aymptoms :-- 
A Binkini; at thu pit of the stomach, vbicb ia relieved by food; but 
immediately on ttikinp it, nay, oven ilnring mastication, an nrgimt 
desiru Mixea the patient to relieve the bowels, which may constrain 
him to quit tho tabic. The motion* are solid, or Komi-Holid, nenally 
coDtaining lumps of half-digested food. The disease appears to 
dopond on rxocesive poriittnltio notion of the Nt'imnt'li tind intcHtinos, 
whereby the food, before it is ilige&ted, is driven from the stomach 
to tlio inloatintis, and thence expelled. ThiH form of diarrhoMi ia 
common with children, eight to twelve years of age, and may last 
mnny months. Ar«cnio in a few days will prolong the interval 
between the meal and the evacuation, and in a week or ten days the 
diwMMe will give way. I ulwnys give one or two drupn shortly beforo 
each mool. (See Opinm.) Arsenic often proves naefol in other 
chroaic forms of diorrhcDa, ovon when doo to sonons organic diseam. 
fut the bowel nlceratJon of phtluMitf. >tc. 

Arsenic hw been etrongly recommended in cholera ; especially in 
th« later Rt«g«s, when there in much eollapso. 

Arsenic enters the blood freoiy, bnt tlio olfecta of this meta! on it 
aru unknown. It has been <lcteoted not only in this Elaid, but in 
most of the organs of the body. 

In frogs, according to Sklarek, in alinnt five minutes aflor poisoning 
hy Arsenic acid, the animal lies flat, with extended extremitin* and 
without broothing. Pinching, or other irritation, excite« neither 
refli's ncticn nor voluntary motion, though niuoh voluntary power 
remains, nincc, on lifting the unimui, or witlidmwing n log, or tnra- 
iog the frog on its book, it displays active voluntary movrnicnts. 
Tn u short time, however, tltc aniuud bciinmuit completely paralysed. 
Arsenic, therefore, poralysos 6ret sensation and reflex notion, iknd 
some time afterwards volnntaij- power. This Occonnt of Sklarek's 
corresponds with my observation of the order in which the symptoms 
occur after )ioisoning by potash, or in mechanical nrrast of the 
cinnlation dorisg tho rammer months. My vxperimentii with 
anHmioos acidi disBOlved with the aid of a small quantity of soda, 
made in October, do not agree with Sklarek's occonnt ; for I found 
that senuUon and reflex aotjon persisted as long, or longer, than 
voluntary power. 

SUarek nttributvs the general psmlyaJA to the Action of arscnious 



302 



i,wnie. 



ncid OQ Umi cord. Mj* owq exporimeote, oondncted with Dr. Uamll, 
twnfirm tliu irtat«iiu)nt i bat tbej ibow al» that arMniniis acid is a 
pualfMr of the motor and aenaory nerve's, and of the maaolei ; is 
fact, like potMh, tArtar-emAtii; and iicooitia, it in a protoplaaoiie 
poison, destroying the functiaiiaJ actiT-itr. flr^t of Hia orotnJ 
nervooH sjvtom, next of tliu nerves, and laitt of thn miiscloa. 

AremiouB acid quickly arreata the heart of cats uid fro^rs, aad 
pro^blf nf othOT nnimnlK when adminifitcrod in large doses. Thia 
L'ffoct ia due to lh« direut action on tlie head : (or lunonioiu aoid 
arrcBtd tho frog's licnrt ulirn romored from tba bodr. Aa araenioaa 
acid is a proto[>luiimii: [loiitou. I anggot that it kIo});! lite heart bgr 
affecttDgall it« atrnctiires, its gaaglia, its neri-ee. and its tniutelc- 
Araenions acid low«ra artorial tension; imrtlj-, it iH tlinu^ht. 1>y its 
inftnmco on tho Ta«o>.motor nerves, but also ovf'uxff to its aotioH on th« 
hoart. Bohm and Untertx-T^r find thai nrscnio eapncinlly reduces 
arteria] preasure in the abdominal vessels. 

Immt coeeladM fnm hi* •ipcrlmtnla tb«t psmljri* ot Uio bMft la pieoedcd bf 
ili(bt aaJ tmulent Innrued irrlubllilf, Knl(ntlng the liutt'* best* in wis- 
hliMtUd kultnali. largti dcH*, bonBTFi, at odm de^mu tlic b»rl'i kKlon, Mil 
tba bIoO(l-;««Mnra «t onet fall* Id Ibt soiU. Ht nttrlluM ihc iatR«>«<l In^utmrj oT 
lb* pnlae I* deprtMion o( (be ragi and Hinalailon of Ibe catdioe i^itlia. Tb* 
japrwnoa fnn latga date )» uoribM la ilcpnnioD of wrdise BSflia >Dd •llaaUUaa 
dt THi- Tbc TatJ, be ML****, an Ant itlmaUUtl and ibrn dtpnawd, Anenli^ bs 
Asda, doci not affect Ibn oowlcnut aerria, nor tbc Tau-iuotor etau*, nor vsao-Matw 
ncrn*. nor tiin muKuUr lunn <d tbi tmmU. 

Antnio al Am >il[ualat(a. Vat laifor dOM« Mon nUnpiidi lb* tititabillly «l tte 
nqiiraMrj fcntn. The prinaT)' itimnlation ii navtr crtat. SnaJI Josh itinatito 
tbe termi nation* oC th« polmoBai; ta(). Ananin SaonaaaspeiMalHa «f IbalataMiaM 
iij Jlreot ictian oa tba gugiia in the lotMllooI walln. 

Ha find* alM Ibat aratniu dimiaubvi tha imUbUily ol Iba mal«r aNY«s and 
muaalai^ Md fint iiimaUlM >ail iban |«r>lj«c* th« apinal conL Hi* rtji ariawsla. 
than, for ilia mwl part wndrm mj concliuiaot tbal ananin ii a prMapIaante (sfaM | 
bnt hs iaila that it Hot itiRbllj and tmuientljr atinialaUa manjr alraelora*. 

Dr. Mumli and I noticed that iu U'n to Iwoiily minatea kftar 
injecting m anuiU quantity of arsenic tinder tho akin of a frog the 
nninw^ g*']><<a> keeps its month open, and sometimes pnt^i its paws 
into its month ; it looks as if siok, and aooto frogs actually vnoit. 
Afsento, tborofure, aols as an emetic to frogs. 

l)r. MnmU and I won ostonishod to find how very fatal Braaaioiui 
aoid ia to frogs, for toUs ^ ^^^ wviflbt of the animal pirodnoed 
conpletu paralysis in 108 ininDt4M, and f gjini Icilled the frog on Ibe 
third day. We found that froga are much more inHaenood hj 
nntenion* acid diMolrod in a suiall quantity of woda than by nnMninto 
of seda I one.flftb of n grain of arsenialv of «oda reqntren elevan 
bonra to ptodnoo ootnploW paralysis. 



AB8IK1C. 



SOS 



i 



Thv Btntcmonte as to the elfecUi of araooic when takcu fur a pn>- 
longed period are Htisngcl; conlliclinf; ; yet probftWj- all arw true. 
fboogb ftt prceonb it is imprntdihlo to rcconoilo ih<> oppoaiiiff stato- 
tneuU. 

Some Boimals. ah the borao and hIiccj), cmi tnk« cnnsidemblc 
qiuwUtiiM of ftnxxnic, not onljr without harm, but with appanmt 
beaofit. 

It is now establialiod beyond raiEonftblo doubt, that id sonui parts 
of Iiowur Anntria, ns Slyrio, umoy of Hm iiihabitftnte> are occiut* 
tomed to talcu cODsiden-blo qiuuititios of arsenic, nomutimiM as a 
condiiiHint witli food. It iasaid Ibcy often oat it witli chocsc. Thej- 
nsuaUy be^io with a small doso, once or twice a w«ck, tli« qanntity 
being gradnally incrwiAod, uutil liaU a groin, or n grain, or cwa 
nioro, is taken at ono time. This bnbit teems to indncc no luto- 
ward aymptoma. Antonio ia eaten for a twofold purpose. Tbo 
women, and eren tbe men, tnko it to clear the oomplexton, and to 
improvo tbo perreor.al appuaranco ; and it in »aid to eCoct thoM 
obj«ote. Tlie men more freqaeatlj use it to enable them to nndor);^ 
grsftt exertion without fatlgno, and tbey nuuntnio tliat it enablm 
them to olimb monntoins and aocomplish fatiguing tasks, impossible 
to Bicooinplish witlioiit it. Tbe expertcnco of most couutnn is 
opposed to the Styriim praclico ; for it is gouorall,v found that tlie 
long-troatained administmtion of ataenii; fiiJU to induce tolerance of tbo 
drag, baty on the contrary, entails serious oouaequencoa. Even in 
ths aiwDic-eating conittrivs, the babit is not without risk ; fur tlutro 
it is a gonsntl opinion that many Ml rtcttms to tha drug. It Imu 
l)een supposed that, taken to an insolublo form, tbe araenic is not 
alworbod at all, but pa«i» out with tbe motions, leaving the Byst<!m 
nnaffeoted by it; bnt Dr. Haolagan'a investigations offectDally 
diapow of this supposition, for after witnossing a well-known arwiniv 
eater eat arseiiio and afterwards oollucting his nrine, a eonsiderably 
<iuantity of tbo poison was obtained from it. 

Ordinary ex[)eriouoe, bowowr, showK that tlie long-continued vae 
of arsenic produce Herioos symptoms, evidenced first in tbe eyes 
and stomacli. The eyelids l»com« slightly cedematoux, the lower 
lieforo the oppor ; wliilo usually at the umo lim<^ or soon after, 
{(light ooajunctivitis occurs with suSuMon and smarting of the oyos. 
and somclimea dimness of sight. The muoouK mombmne of the 
DOM, mouth iknd throat way be reddened and iu6amed, giving riso 
to thirst and dryneasof tbu month aiidthroaL In some, tha digestion 
Iwoomes denuded much sooner than in others. Th« appetite fails, 
and at tlie pit ot tbo stomach a gunsation of wttight or sorvness is 
ffilt, aggravated each time on taking food or the anenio. Somelimca 
the stomach is aSoctod before tliv eyea. On the appuaranco of auy 



304 



ARSEKIC. 



of tBcM! aTliipLoma tbft drug mtiat be f^vtn iu tiuftU«r qtuuitltiei. w 
be discontinnod. The ekin bocamcs drj and dirtj- looking', and ft 
iOi|{1it " brunnitiMa " may be noticed, moat marked where the akin It 
coTorod with clotbcui. BcKcnin or nrlic»ria xnaj Arise, or perliapi 
Tcaicalion or mere de^riuainatioii with tendemeM of the pRlnia of thtf 
hands or boIob of the fret. Amunic ia wid to have prodnoMl 
pityriaitiR and Iiehen and aching jiains in the head, and KWvllin^ and 
inflammation of the joints. Sleep maj be inach broken, or d^l 
turbed by dreftmR. 8till more serions ErymptoinB set in. The voH 
becamM rongb, and in some mws nEilinition takca place Uloen 
maj form in tJie moulb. Nausea, vomtLinfr. and diairbcm, sot in, 
witli slimy and bloody motions, voided with mnch etraining and 
pnin. The hair, and vv«n the naiU, aumetimuH fall oS. Congb, with 
bloody expootoration. may occur. With tbrac soriona aymptoma the 
patient wastes away, the skin becomes dry and hot, the ptilse tn- 
qnent, especially at night. Pains in tlio limbs, nenral^o pftiiK 
animtbecia, trembling, and even paralyslii, <Mimeon; till at Ituitthe 
mMnOTy failH, seneottion ia lost, and death Boon follows. The avecepti* 
bility to anwnic varies ; some being apeedily aSevted by tiro-drap 
dmM of the anenical solution, while othen can take t«n to twenty 
drops without injuiy for a considerable linio. Or. McCall Andatwn 
ataU-a that patient« while talcing nrKcnie are Hablo to bronebitia, and 
ahonld thpreforc bo cantionod ngninst cxpnaure to oolJ. 

Oie« finds that the prolonged nso of nrsunic in increasing <1orm 
continn«d for months, has the aamo affect on the bonoa of rabbita. 
pigK. unil fowls, na phosphorus. I'hii bonM baootae more oomp»ot: 
thi-sv changes beiginning in about thrve weeka. Tbe animals becama 
heavier and bttor, and there oocnmd fntty degMiarataon of tbe 
htart. liver, kidneys, and spleen. 

A \MTgt) doKQ induces the symptonu of acute poisoning. The 
areenic a«ts as an irritant to the whole digestive eanal, ex<-iting vt^ 
active inflammation in its dolic*t« mncoiiB membrane; ac<-r>rdingly 
tlw symptoms to be expected ftnni severe inflaninialion of tliia ttMet 
•el in. Bnl, stimnge to say, tlw symptoms following a tarpi 
poisonous dose are not invariable ; the symptoms ariaing from acmie 
inflainmntion of the digestive oanal are most common, and pRi|fl 
fatal in fonr or flro days ; bat eometimea the aymptoms are •IbmI 
or L-»tirely ahavnl, and instead of the patient running lEu osoal 
ooume of araonical potaouing, profound ooma si^s in, from which he 
never wnkas, but dies in a few hour*, the mucous membrane of the 
atonadt ami intestines l)eing free from all inflammation. Setae* 
tliBas llie aynptoms nre wry like those of Ifnglish eholenk. 

At the [HMt-mortom the intestines are lilled with rioe-wator Oaid, 
with epithelial Bakes, the vpithetium being in a state of advADcvd 



ABSEXIC. 



305 



f»tty (logeoemrion. The solitary and agminated f^lands are much 
•wollen. (Virt'liow.) 

IJr. Btoclivi! (IcHcrihee ADolhor tonn of nrseniual poisoning char- 
ai^^terized by i-liulerBio djmptoraH i>f the intestinal canal, with (iui>- 
preesioii of nrine, cnHnpe, and progroraivo coldiieiA of Iha body. 
convnUions. and locolixud pnmljniH eapeoiall; attuclcing the oxton- 
mn. If tho patient survires long enoagh, « potechial, papular, 
rcBiouIor and wbe«l<-lik« rtwh often appcara from the aecond to the 
fifth day. 

A fatal dose of an^nic lowtrd tho t«mpemlure of dogs and rabbitu 
4* to 7' Fah. 

Even when injected into the WckkI, or applied to a vronnd, arsenic 
prodooea its local effects on the digeatiTe canat, being found in tho 
iuteatinea, showing that ihi* i« om- outlet fay which tho poinon ia 
diminatod. Whon tJie metal is injected into the blood, or absorbed 
by a wound, the elTecta on thu Ktoniarh and intratinoa are nnid to he 
as BOTcre as when it is swallowed. Thin i* iii-rhajw hardly tmc. 
It in evident fn)m the foregointr facts that arsenic mnnifcMlA an 
cspooiol affinity for the nincons membrano of the inleiitinnl canal. 

The pOBtumoiiem oxjunination iu acute arsenical poisoning shows 
much inflamination of the stomach, often in pat^the*, in which 
arsenic powder is rixlblc, iinlteddcd in tlie thick viscid mnciis. Spottf 
of ecchymosis arc sometiniee seen, and less commonly ulcttntions. 
Perforation is rare. Tho owophagna and intestines may undergo 
inBammation, often most sovere in the rvctum. Occasionally the 
month, throat, and oven windpipe and bloddM-, become inflamed. 
The otiriom fact hmt been pointed ont, that notwithatanding Uio 
oxistoaoe of symptoms of inllauiiuation, yet sometimes no traces of 
it an< apparent after death. This absence of inflammation oumol 
bo explained hy want of time for the arsenic to act ; for in cases 
ending in doAth yotmore rapidly, severe stmctorid changes ore to bo 
found. Death may occur in two houm. K('chymo«ia is commonly 
met with under the lining of tho cavities of the h<tart, and if tho 
patient surrives long enough, a petechial, papular, or pnstnlar rash, 
or wheals of urticaria may oconr. Neuralgic pnins, aniestbeeia, and 
})aralyais an oomutimes seen. Like phospliom«.it [irodncCK extreme 
fatty degeneration of the liver, htnrt, kidneys, and other structures. 
Kther, and even chloroform are said to produce similiar effi>ol«. 
Both in arsmical and antimoiiial poboning the Klfcogenio function 
of the liver ia uiid to ho destroyed. (Sarkowskic.) Arsenic retards 
putrt' faction. 

Id chronic arxcnical poisoning there occur dryness and irritation 
cf the throat, irritation of the mncoua memlnsneci of the eyes and 
Bostrils, (Itj ooBgb, languor, headache, loas of appetite, nausea. 



306 



AKsexic. 



colicky pninsi Diiinbiiiwi, cmmp, irriUibilitj oE iba bowelit attondwl 
with roacuB discharges, grant prostration of atiragth, a feverish 
oondiUon and muiting of the Imdy, sloopkNtiMim, giddinons, lunaculor 
trnmnn, eren convulsions oud )mnilf sis. 

Drs. Cutler nnd Bradford, from llieir esporimcnts condactcd 
itcoordinK !•> Malasaez'a lOL-tliod, nro lad to cuiialndv tkttt " ftnwnio 
Kivoii iD liealth causes a pro^roKsive decrease of tha nnmhor of tho 
rod and c«p<!cinllv of llie white cnr]>iisck'H. In siniplo anseniiA, on 
thu contrary, tlioro focois to bo an incroieo at first of boll) red and 
wUito norptuclcit. After ft certain point t)i<;ra in a at«idj diminution 
of botb." Arseuiu is nscful in cblorosis and anffimta, aometiniM 
anocooding when iron hilK nnd disnf:mt!8. Scinio bold that tbff 
effiottcj of irou is increased by the addition of arsenic. 

Arsenic, in modorato doMS, it in Mid. givos fulnvM nnd loc: 
Ktrength to the pulse. 

Some give an>enii! in proi«tnkting tM:ut« fubrile disooMW, wiUi tlut 
«ffeet> so tb«y aver, of strmi^^bcning tbe pulse, raoiatening tho skin, 
and invififoTatiiig the jnttienl. 

Dr. Bay«s recommonds arsenic for the swelled feet of nli) nr 
w«akly poraon* ; or for old people w-itb a wmkly acting heart and 
feeble oirenlation, irbo often euifer from brcnthlcasnesH on lisertion. 

Anmnic haa long been rocommendcd its an excclloDt ronicdy in 
apaamodto diseasos of the langsi it is ofl«n usoful in asthma, whether 
or not depondent on empbyaeina. 

- Arsenic oft«a givoa groat relief to a vlnss of empliyMnmtona jm- 
Bons who, cat catching cold, aro trotihlnd with a slight wbetv.inir "t 
the cheat, diSlcoIty of breathing, espevially im oxtTlion, ur at night 
timo, and ore obliged Ui be inrtiatly propped up in bed ; it appears, 
however, to be of little service when tJicto in very much bronohitia. 
or wlten tlte patoxyama of dynpnoat arv very nr^^t. Id this con- 
tlDKi>ni.-y lobelia or beUadoona anavrent better. Araenic is npc«laJly 
UMfnl in tho forof^ag coMK, wbore tba difficulty of breathing can be 
uonaeoted with tlw retrooeasion of a rash, iis ecMttna. Ainonio ||«mr> 
ally roliovcs the whceaing with opprcRsed breathing, whioli aSeota 
aotne obildrea for months and even years, and is pTobnbty tha <iom> 
moDceinonl of nathraa. 

Araenio leosons the carbonic acid of nespiralioa. 

The benirlicial influencu of antenic in certain skin dJaoaaoa, (lartica- 
larly iu tJw aoaly cmptioaa and in chruniu i.<c»o]nB, ia uniTemaJly 
reoogniaod. Lepm almost always yields to it, and ita affloacy ornr 
other forms of {MorlniUN in liardly Ium marked. Uaay caaea it cnrea, 
tflhura it tmpriirit*, but a few it leaves anbonofitod- 

Hunt, who lias ha<l more vxporMinco of this remedy than perbapa 
any otiier poraoii, litid down oxoolteot ruleii for guidance. Uo roootn* 



^■^^^^^■^ IRSEXIC. ^^^"^ 307 

mend-i Kmall doseH iln capable of oJIectinf; all tliiit in jnaaahh bj 
lirvonic, and diHcatinU'iutiOM tlitt prnotiov of gr&dttftll^ incroneing the 
dOBS. If toxical elTocU arise, be adriaos, not the disco ntinuAuce but 
tfao dimiDation of tbo doita 

ArMBic ii hurtful during tbc inflaiunittor? abgn of ornpUou. 

ClillJmi iboTB fiv0 j*ut vlU beu n dM« nearlj u Jaigs m kiIuIU ; •nd it u onrion* 
tbttt gitli o(Un ttqnitt n l»rg»t clow tlun lwj«. 

Til" ItrjQti iloM VTer nquiiwl I* Gtc mioitni. rcptukd llirR* lime* * dij : Wt *i)n)B 
practltiODCni giro double of «tc9 tr«bl« tbit qnantity. Ai n rale iC ihoaU neter bo 
|lten on an fntitjr tMiuoIi. 

Aiwnlr, If tnlii'd irith lani, don not uusll; IrrilAtt lb* boiraU. In Uio Mam «t k 
feu' d>yi 01 ncclu ll will prodOM kn Itcblog or nnullng in th« <ODJsn<^tin. ftnit Lbu 
msmhniTic oil] iptiru' >llihtlj induood, tha lown ejtlid bvcotning it liltlo ]iu<I«d or 
twollen nt Ihii puint. Tho eatuiMui diwuc vill nu« b*cln to dMUac, ud tbo doM 
moat bo reduced nno-(tftb. 

flliniild tho vonjiitiotiTs uotitinac cmcb indained, tbo iIom mimt b« xUlI further 
redunid, liat Ui« tonjanotin sbould li* kp|>l allMWd tlitonKtiout llio wliote CDono. 

If tbr ikia bcooma luort lnd>iDol, tbo coim rontl not bo inttrmptod, bnl an 
ooewionil npcrieat n»t bs lokra. 

Tbo ani'niral trtatnimt taarl be oanliDoed for u minj moulba after tho flna) 
iliMppeamnco ot tbs wnptlOB ai It fau axUlal jeari \)thu. 

ThcuiT ralea oIomIj oorrMpond to tlio luU-ion giveit hy Dt. Grave* 
in hi§ clinical leotnrra. With two HtAtvmutils iniide in tbis " code of 
ra^nlBtifliM " my L'x|iork'ui'c iIock not quito oorrMpond, for I have not 
found that amnrting of the eyes ucd nvretling of tbo tower Kd occur 
BO ofton 0» Mr. Hunt implicfl ; nor do I find it neowtttry to induca 
thcHO toxio symptoma to instiru ibo beneficial iafluenco of tho 
roaipdy. 

Thu Gnt influenoo of artienic on ptuirin^ia is to make it rwlilfr, 
more iDtlamod.aod to look worse thitn hoForo treatment, a fact wliivh, 
if not known, would l«ad to tho iiiispt-nHiiMi of tho drag just wlira 
it commenced to dn good ; but tho oxaggvntod rvdnotts aoon deoliiws, 
the emption beiila in tbo oentie, loarin^ in a short time onlj a alight 
TcdnCKN. 

Cbrottio eciema, altbouRb jrarbajia not so amenable to arsenic aa 
psoriam, in genemlljr boticlit^d hy it, oepocially tlto obrtinate cbrouio 
forme. It toiaotimoa removes tli« rebellious eoxema which infeet^ 
the rutvn, (ho verge of the nnos,and tlio scTOtain. 

Amntio will gcnemlljrcnro thni ti-oublesome disease pemphi^ns, as 
Air. Uatohiiuon has shoirn ; and allhoogli after a variable inten-al 
tile eruption ia liable bt rccar,itwill again yield to a renewed connio 
of tbi' (Irng. 

Arecnio sometimn relievos lichen and other obstinate skiu a(Toc> 
tionx. 

In our experimenta on aiwniouii B«id and tartar-emotio, pabliabed 

x2 



SOS 



AISESIC. 



in the Jounutl (jf Pkyiiolojy for \879, Dr. Mnrrolt hik) I fonnd tluU 
tkese two BabitimccB protlnccd dosqounatioD in frog*. Tfanii, after 
potiMminK by uaeniona acid, even witb only x s in P*** "f **"> weight 
of iht! luitnuti, deoqiuunatioa be^iiiB od the trsnk in about five boonw 
in tlw lega in about cigbt bonn. The catido etripx off in \MTgo 
piMJCs, to resdilj that mere bandtinff the animal detach«e it. Tartar- 
etnetic affeete tbo cntidc apftarttUlg m a HOmcwliat diffcront wny; 
it changcN the ruiicltt into a pnlp or jellj-, so that even vrbiLit the 
frc^ IB alive itcnn bo scraped but not torn off. W« conclasiTolj 
tOiowod thnt tbc«e «ffectji are due to the direct action of KmenioDS 
acid and tartar-emettc on the Blcin. 

Doe* arconionii acid affi>cl all epithelial structares in thia wa^ ? I 
Ibiuk so. Miss Nnnn hag tbown that it affccta i\M comeft. And 
after aoDbi poiMnin|; the bowels aro fonnd filled with a Tic»-water 
flnid, consisting of epithelial flake*, and tlui epilbolial oolU an 
choked with t^nules, and some in a stale of advanced fatty degene- 
ration, and those changes oocnr even when the poison is injected 
into a vein. 

Mias A. Nann, Lecturer on liiology in the Wollosley Collegv, 
Bosttin, U.S.A., under the direction uf Dr. Michael Foater, kindly 
iDvratigBt«d microaooptcally Ibo action of araentons acid and nf 
tartai^«netio on the akin. Miss Nnnn showa that tJie pecoUar effect 
of tboM Babataucea ia limited to the epidermis and leaves nmkfTocted 
tbo corium, with the exception of incteasing the qnanlity of hlcrod it 
contains. Miiw Nairn aaja :— 

" An examination of a series of sections taken from different part* 
of tbo body at different intervals nftpr the (hypodermic) introdnc- 
tion of the poison, shows that the general effect of armniotia acid on 
the epidermis is to cause a ttoffeiio ration, and partial solution, of the 
protoplasm of the cells, when^by (I) the whole epiilerm beooioM 
loooesed from tho snbjaoent derm, (2) the cellti of the malpi^bijui 
boooma incoherent, ao that tbo whole layer collapsra, and itH well 
' known architectural featarea become obacnred, and (3) the inter- 
madiate layer aepaintvii from tho malpigbian layer below, and at 
tinaafimn the corneous layer above. The eomeoua and intormediat*' 
Inyeni are tbua deHqaainaled, Bomotimi'K M'parataly, Mmetimoa, atwl 
[•orhaps moat frequently, together. In no caao, even in those of 
moat extreme or moat lengthenMl poisoning, bare I ever seen tbn 
malpighian layer actaaity cast off dDrin^; life ; it always ronaina 
attached (thongh loosely) to tbo derm in a manner which I ahall 
prcaently deaoribo. In preparing sections, bowerer, it freqaentljr 
beooniM wholly detached, 

" It ia obviona, from the foregoing aooonnt, that the arsenio &mt 
hllaeka Ibe lowemoat or innormoBt portions of tbo epi<ien&, and 



Amemc. 



309 



that ita acttou advances from the derm outwnrds. This may be ld 
part due to tho Bimplo fact that the tnnnnnoiit uuDh nra thoM which 
nru Dcari'st tti tlii! blooil-vcsNuls CRrrj-ing the poison ; bat this can 
li&rdly bu the >vbok reason, ainco diSniion mtwt bu verj rapid 
through a thin Tncmbmnp of edcL a nature aa the epidermis. It 
aoenu uiuro natural to attribut<i tho phonomcna to tho fact that 
tho cells of tho Rialpighixn layer next to the denu (the cotmniiAr 
layer) ore Dompoaeil uf moro ■otire, moro irritahlo pmtophuiin th*» 
that of the rcHt of tho dorm, the irritability diminishing in tho 
Mriei of cells from within outwards in jirajxirtion nii tliii meta- 
morphosis of tho protophuun into Icomtin becomes moro and moro 
pronounced. 

" I never obsorred any cxcras in the flaidn excreted by the skin 
gcnomlly ua the result of nrsenio jioiHOning, and it iit impoituble Ui 
explain the ohanjfojt doHurilwd almvo n« morcly dno, or as chiefly dne> 
to an fxceimive discharge of fluid from thn ontoncous blood-rcasels 
«r lymphatics loowniug and Kcpamting the cells. All the fnct« go to 
provu thai the changes are the i-osult of the anenio actlui; directly 
on tho epidermic coll, which with its diminished cell-substonco and 
shmnkvn nucleus, proaeutM a striking analogy with the aooretinjf cell 
(at a. salivary gland) which has boon stimulated to exliaostton ; and 
1 ahull proLn.Uy not go far wrong in nigurding tho chnngCH of the 
former aa tho oonuqnencu of an action of the poison not wholly 
uidike an exoessire, in faot. a lethal trtimnlation, by which the 
dostmctivo stugtw of tlio metaboliKm of the cells are hnrriod on 
bq-ond the ruparative power of tho constructive staged. 

"The stimulation la obvioualy of a peculiar kind. One marked 
effect of the stimulation of undifferentiated protoploam ia to forward 
ajtil accelerate prooftMos of growth. I have looked diligently for 
indications, snoh aa double Dtiolei, Ac, of maltaplicatiomi in the 
epidermio cells, bnt always in vain. One would natorallj expect 
that tho changes which 1 had deecribed would, if tho noimal lived 
and recovered from the jwiaou, be followed by a rapid renewal of 
the epidermis, but 1 have nob as yet succeeded in keeping tho ani- 
mals long enough to see oven the first trace of it. I may remark 
incidentally, that the fact of the columnar layer being (hn firai to 
be attacked by the poison may perhajMt bo regardt<d aa an indica- 
tion that the growth of tho epidermis does take place from thia 
iayeTt and not, as recent ruMean^lie:; on the structare of the mam- 
malian epidenu havo Euggcstod, from the cdla of the intermediato 
pnrt. 

" The characteristic vortii:at arrangement of tho nndermost cells, 
the oulamiiar layer of the epiderm, is a jihouomenon for which it ia 
very diSicult to account. Embryolo^cally considered, this feature 



310 



AUIStOL 



eeeoas to be a continnAtion of tli« condition of tbo primary cpibtast, 
Ui« oalls of which nro olvmys rvrticol ; bat it is diffiuuU to see wlmt 
piiT7x»e is served I);- tbo preserration of tliui imcwtn] funturo. It is 
obvious, however, from tbo rvntilU which I hare giv«u, that till* 
vertioil poBition ia maintained (lor whatoTor nmaoa) by somo ezer* 
lion of tlio protopla&io of iho vonAtitaont cells, lauucdtstiity tbM 
tho Rrienic dunaKen the protoplnsm, the vertical arnuigomeal is loel : 
indosd this is the moBt obrioiu offoct of tho areonic. snd tho ooa 
moat K«dily reoognised." 

Concerning tlio action of nntimniiy iiho uys: "The stniatani] 
chiineas in tho oiiidermis bruo^t abcint by sutitnony sra MMOtlal^ 
tho mmc as those produced by araonic There U (!) tho mmv 
msrhed degenemtioti nnd partial eolutiun of tho ootamnsr Inyor 
which oMiSM tho epidermis to bo lield tcfs firmly to the ihtrmis ; 
thoU('b previunn to tbi; hiinli'nin^, the extreme softness of tho iwlU 
provcnie it from boinKalripped un-ay OS van be done iu tho csMt of 
arocuio. Tbrni in (2) tlin luinie diT^ntemlion and aoparatioi] of all 
the cells of tlie malpighian layer, and (3) tho Muno dosqmunntiou of 
tito oomoona »n<l intorraediato layom. The principal differeiu-u in tho 
p<»liOi' softnoMi or more complete isolation of tho veil*, nn<l the 
somewhat more marked change in the intonDediat«. layer. The colU 
of this layer appear more UioTongbly detached from one another, 
and kenoe caTitien aro mora froqnmtly found between bhoD; bat 
tJwtr protoplasm is never formed with tlireads and proceBSM ea. 
dosing Rpaocs, aa in the columnar oclhi. It i» tliis separation of tho 
constituent oells of tlie intermediate and also of the malpiphian 
biyor which \» the chief determining oausc of the polpy or mucitji- 
ginous oondition of iikin in tuitimony poimnin^' ineattonod by lliniror 
and UiutpII. Altogether, the action of nntimony is more rHjiitl tbui 
that of arsenie, and tho ohangea produced by it bear eridot)c« of 
more riolonoe. Bat tho marked ohaago in thooolmiuiaroaUit mnaiBa 
Uio most cboraotoriiticfcntnre among the Ntmctiiralohangwptwliuad 
by liotb arsenic and antimony poisoning. 

" Uotli those dmgs, (hen, bare a specilW effect npon the oolls of 
tiio epidermis, the one diOering slightly only from the otbvr in their 
fnadamental action, (h<ingti the remits appear l» the naked oyo to 
divetiqifl eo largely. The Hkin, under the inflnnico of eitbitr dm^, 
proMMite a striking eontnut to one which Ins been left (« tlisuuto* 
gnUe in a natond manner after death. 1 have examined tho skin <tf 
Cmga at intorrals of one to seven days after death, tnit I have nomar 
observed tlii> |ii>cnliiir u)uuigo> whii'h T bavi'iicsL-HU-iI atotTeii* lukiqH 
plaoe in tlui c<iliiiniuir cells. The ooUb iif tlie wlutlv opidermiN 1m-uoh^| 
gnimUr and moru opaque, and the outlineH of tbo oolhl Kt'omp 
indistinot ; Uio oonioous layer may ho thrown oil, aud the fmttuiwa 



IKSKXIC. 



XUl 



nf the malpighinn lafer Ijccomo, orentuaUy, roty diSioaU to rccog- 
nue, but at no irta^ dor« t'itbiT tho prcitoplatm of Ui« cell* becomfl 
eofloDcid in the pecnii&r manner descrilied, nor do the nacloi bocotno 
Mlirunkcn. Ttici denqunmKtion undor antimotij and vwmio ia ab> 
vioosJy A epocilic effccl." 

Mi»it Niuui findti tbat KntiiiioiiH ncid and t*rtar-pmotiu nifect l)iu 
cornea in a similar manner to the §kii), bnt the eiTecte arc never xo 
iiuirked as in titv ckin. 

It is interesting to obsorve how those experiments oonfinu the 
couolusioiiH pruvioniily nrrivud at bj oUuioal Kludj. Thaw invcutigH- 
tions bIiow that tmonic nITects tbo epidermis moinl;-, if not exclu- 
dively, nnd luaveti thu <lcmitH miaffooted. X>r. Dulirintc. in VCoodV 
" Tlieropeatice," safs, tJint disMtSM alfocting tha moro saperfioial 
part« of tbo nkitt arc moitt ameiMblo to tJie inducnec of nrsonic, and 
that it posseBses little orno inflnenoeopon diMnaos seated intbedeepoT 
stmoturcH of tlic nkiii. It bos no «ITect upon infiltratioiui i>f tbi; 
cor i am. 

»w, if Mij, rcmodiLie arc m Booccasfol in vboraa an araenio. If 
there is much aotraaia, iron is rsquirud ; if fcvi^ or rbcnmatiaia, 
thoiio ma«t be ntbdiiod b; appmpmt« trmtmcnl. Bnt in simple 
nncomplicated cases of chorea, arMnic is far tbo best remedy. Iw 
oocanional non^noecHS is sometimeB owinji; to the undue auuUlness of 
the do»e. luid decided improvonient often bogins simaltniiooDsly witli 
a freer nilmfnist ration of the ntedivine. When chorea baa rexiotod 
emaller qiiaotitiesi children may take four, firu, or more minims of 
the solution. In ouc auiii which rapidlj- improved, I qniokly increased 
tJie doae till the boy took twenty minims nf liqnor ArsenicaliB six 
limes a day, antl in nnc>lh()r Mnooeeaful case the gii'l took fifty minims 
of liquor daily. Ur. ijeguin givm two to bvo minims at tiret and 
cinickly inoreuecK, adding a drop to each dose daily. If nnwuical 
symptoms arise, he intermits tbo arsenic for forty-eight hours, and 
tlien resumes it at tho Inst dotw. A remarkable tolerance is now 
shown by moat patients, and dosos of 20, 125 or liQ drops tbnce n day 
luay be reaobud. Pimorid uses amenic Itypodormiiwlly vritJi great 
■ocooss. Arsenic is well borne this way and does not deiange ihe 
etomuch. 

Ur. Uughes and Dr. Cooper highly oommend small doses of arwaio 
in niiuralgin. Dr. Anstio also Kpoaks highly of it in variouK neural* 
giaa ; and in angina pectoris, a diA«se he reganloii as a nenralgia, Ue 
statiw tbat it will lessen the wivority of tlia attacks, ritdiieing them 
in time to mere " tiglitaesa of tlie ohest." 

Arsenic has twon found servioeaUo in epilepsy. It not nnfrc- 
(jacntly onreti dull throbbing paiii aftootiiig one brow. 

With the exception of quinia, no dmi; snUlnes intermittent fevn* 



312 



110. 



like arsenic. Somo iiuloMi wttb Ui^i^ experience count tLraenio 
eqiiftl, it not superior, to bftrk in ngoe. The greater tnuober of 
obeormv, faoworcr, do not credit arsenic with suck pro-CDaincnt 
virtues, maiatuaing that cinchona euros iho (Linuuu more quwklj 
and more certaiulj, nad that it i* (wpuuinllj to btt prefemid in thoM 
malignant fonna wliicli, unleaa at once arrested. Bpecdily destroy life. 
A concurrcncu of t<!>itiinon)r traida to iihaw tbat ftnenio is most 
n«efnl in long-standing agues, esjwcially of the qunrtnn tyjio. 

A long-continued oonnw of araenic i^ recommended in epithelioma 
nnd even ecirrhaH and rodent ulcer. 

Antcnic biu latclj been extolled in phUiitiis and tuberoDlosis. Itis 
said to improve the appetite, increase aSBimiltition, tcascn expocboi^ 
tion and cough, and to pruni»t(i thu cicatrimtioa of oarities. It ta 
stated that it will rodaco the temporaluro in tuberculoKts, nnd aftsr 
oarefnllj inreitti gating thin iinhjet^t, ! am inclined to beliore ao ; at least 
1 have frequontlj obaerved a Meady and sustained fall of tho tlwi^ 
mouKiter follow tlie uxo of arncnic in cimi'n where the undue tm- 
peraturo had continued unchatip^d for a considerablo time^ uid this 
I hare known bappen twioci or three time* in the same flaae on re- 
verting to arsenic after it hod been discontinued. Tho decline 
generally Inkea place gradually, nnd may begin toon after taking the 
arsenic, or the fall may bo poetpoiied for ten or tirelre daya. More- 
over, 1 liave seen ohildien in a hopcloM atAte, with Hn-ere talx-rmlosis 
inrolring longs, intsstiDW, and peritoneum, steadily and slowly im- 
proive anil altunatt^ly recover under arMinic treatment, nnd I hsTs 
olieerved a like result in adults with phthisis, in the sabaoute and 
ohronio forma. It must, however, bo admitted that this ia a very 
intricate subject, seeing how iiregalar a course tke feror of tnbercti- 
loaiii ninK, and how aometicoos cases the moat deapetate reoovor bj 
naaaa of oilier treatment, or indeed tkrough little or no trcalmtmt. 
Still, I am snro that the action of anionic in phthisis and lulwtVB- 
losis ia well woriliy investifration. In my ex]>eri«nc« it ia ospeciallj 
nieful in fibroid phthidiaand chronic phtbiMH with maoh fibwid in- 
duration. I hare gencmlly given from two to four minima avery two 
lo four hears. Id a few oaaes it is ill borne, prodneiag sioktiOMi and 
pain in the stonutck and bowels. 

Arsenio ia often scr viooabte in rheumatoid arlhritis aud nodosity ol 
tho juiuts, )mt tke indicationii for it« etii|i)oynienl aro unknown. Tho 
pains of this troablesume oileetiun aro somctimwi increaaed, some- 
timM benefited, by heatv noma case* being worae ia rammer, oUwra 
in winter; some are wonw during the day, otken at night. All 
theae forma arsenic will sometimes cure, yet its action is oapriciosa, 
for ill oaaes apparently identical it somotiuies faiU and "-"iirtiinM 
eatta. ItaelTeota are sometimea aatoniahing, for stiScnud jointa, for 



I 

I 



J 



a long time consideraUy enlarged, bocomo redncod to Uieir natumi 
oize, and regain Uit-ir HnppIcncNt. Largo doww nro neocMary. ^v^n 
for a coiuid«nble time, and it must bo borno in mind, tbut it im- 
proreraent does not Rpomlily enane it ninHt not bo coucludod (Iiat the 
medicine wil) ^1. Some consider it necessary to pnxlucn tint toxiu 
cSecta of ai'ienic ; bat in man^ eiucH imiiroTVueut cortitinlj resalt* 
witbont pushing the remedy to this extent. 
Dr. SimpHon mnjiloycd anenic in tliat poRolinr affection of the 

I bowels prevalent among women, characterized by the copions dis- 
charge of membranous shnds. aecompaniod by muoh enincialion, 
•Dd a long train of noamlgic and other nervone Kjniptoma— an 
.ttSvction occasionally oo-existing with dyRmenorrhce*, the mom- 
bmnooB shreds being discharged both from the Iwwds uml nlerus. 
Like other metnls, areenie, Ihongh moro qainUy eliininfttcd tbiiu 
some metaJsr aa loftd, \m rotoincil a tang time in the body. Some 
Duintoin that araenio is to be found in the bonee as aneniat« of 
lime, a Btatomont <tcniod by otlien. It may bo detected in the 
milk. 

It is found in the blood chiefly with the red corpnsclos. It is 
separated from the body by the tuine, the stomach, and intestine*, 
and pprhapH by the liver. After nrecnical poiMOuiug, the metal is 
found in the liver in quantiticn liirgLT than elsewhere. It may be 
that, lilcc many other metola, it is separated from tho body with the 
bile. 

Wc know nothing of its influence on the compoiiition of the orine. 
Some ezperimenlers aawrt that the nren is lessened, and, as the car< 
bonic acid mparated t^ the longs is diminished, iJiey conclude that 
arsenic diminishes tiaimo metomnrphDoiH (o a considerable extent. 
Vogel observed luemato-globnlin in the urine of an individual 
poisoned with areoninretted hydrogen. 

Dr. Garrod states that arwnic acid is less irritating to the stomacli 
than omcnioas acid. 

Some persons are highly intolemnt of arsenie, ao that oven one 
minim of liquor arsenicalis will produce violent action on tJi« stom- 
ach and intestines ; onfcnious acid is poisonons to many of the lower 
forma <if animni life, hut doee not impair the action of animal fer- 
ments like )>ep»H and pancrcatin. (tichikfor, Bohm.) 



314 PHOSPHORUS. 



PHOSPHORUS. 

Ix large doses it ia an irritant poison, bnt the sjmptoma are some- 
times delayed (or honrB, or even days, and they occnr early if the 
drag ia ^ven in solation as in ether, slower when given in the solid 
form. The patient complains of bnming in the throat, with intense 
thirst and severe bnrnJDg pain in the stomach, followed by distetuion 
of the abdomen and vomiting of a dark green or black sabetaitce 
with the odour of garlic, and sometimes phosphorescent. There are 
the nsnal symptoms of collapse. In less severe cases, vomiting ceases 
on the second or third day, bnt on the occurrence of janndice, which 
often happens, the sickness retnmg, and the rejected matter contains 
dark-coloured blood. There is now pain and tenderness over the 
livor, generally diarrhtea, and later the stools become clay-colonred. 
At first, it is said, there may lie fever, tlic temperature rising even to 
102*, but subsequently the tcmpenitnre sinks below the standard, and 
in one case it fell to 89° Fab. in the roctnm. Jaundice sets in &om 
the second to the fifth day, and at first the liver is apparently en- 
larged, but afterwards its size diminishes considerably. Janndice 
may be absent even with advanced fatty degeneration of the liver. 
Tho nrine is generally scanty, albuminous, and sometimes bloody. 
It deposits epithelium celln, and when there is jaundice it contains 
biliary acid and colonring matter with leucine, tyrosine, and para- 
lactic acid. Urea disappears almost entirely towards the termination 
of a fatal case. Haemorrhage and purpura often occur. Wonnds 
bleed inordinately and sonie times uncontrollably. Later, either 
delirium sets in, or coma, which may terminate in convulsions. The 
post-nwrtem reveals most of the tissues in a state of advanced fatty 
degeneration. In the stomach and intestines, there is general inflam- 
mation of the glandular structures ; hence the mncous membrane is 
thickened and whitish. The epithelium is granular or fatty and 
much degenerated, or even broken np. The liver is either enlarged, 
with its cells in a state of advanced fatty degeneration, or is con- 
tracted from destruction of the cells. The kidneys arc similarly 
affected, tho epithelium being swollen, granular, fatty, or broken up. 
Tho heart, the voluntary muscles, aTid other structures are also 
implicated. Tho fatty degeneration afEects likewise the whole of the 
arterial system, down to the microscopic arterioles (Wcgner), and 
the number of the blood discs are said to be lessened. 

Fatal doses of phosphorus lower the temperature of dogs and 
rabbits 8° to 12° Fab. 



FHOSPBOHL'K. 



315 



Tliu mAin stress of the poison sometimes falls on Uio gwiTfi-intes- 
tina] mncons mcDbrano ; KomcUmus cat the nprrons sjstom, and nt 
other timoH on tfa« blood and blood>vesBeU| and in this case f^vt* rise 
to btemorrhitgL'M. 

The diimtion of acnt« poisonin)^ is very rarinblo, tlio potient may 
die ill two or tliroe dnyn, but giuncrally he mtrrivm from one to three 
wooks. ItocovoiiT is slow. 

Jnrgvnsm ul^niA to liuve saved suvenU liTOS by direct transfasion 
of hiitnaii blood. 

The dfeots of ohronie phospIioniK poisoning liave lately been 
elaborately worked oat on animals by Dr. George Wogner, with 
most Mingulnr reitiilta. It Iwji long buen known thftt workmen exposed 
to the fumes of phosphorus are linble to neeroais of the jiiw, niul Dr. 
Wogner bcH^Tus tlutt this rcHulta trotu the direct acMon of the phos. 
phorna on denuded bone, and that necrosis will not act in unless 
through wonnds or carious tuoth there in somG doetmctiftn of the soft 
tiameBi tbns enabling the phosphorus to reach tlie exposed bone; in 
■nppMt of tliJK viciw hv adduci-s tho following rcMunHt — 1. If tho 
poriosteam of an onimnJ is sererely wounded, and phospbums i* 
given in tlie form of a pill, even for months, tho poriosteB] changes 
do not take plaoo. 2. When tho tibia of a rabbit is partioUy bored, 
a healthy gmnnUting wound is soon cstabIi«bod, bat nndor oxposnre 
tu a pbospboma atmoqdiere, periostitis is set up aimiliai- to that in 
tho jaw, 3. Many workers in phosphorBS escnpo, whilst those who 
do suffer have carioua teeth. 

The lower jaw is more often affoctod> but the upper ia liable to 
attuck ; aiKl in rare ciMes eren the palate and frontal bones. 

Dr. Wegener fonnd that gradually increasing doses of phosphorus 
or phosphorous fumes administered to mbbits jiroduood eongotiom of 
the tanoous membmne of the stomach, this memlnwie beeoming of a 
brown colour and threo times it« natnml thiclcncaa. The liver is 
chronioslly inflamed, with great increase of the interstitial tissue, 
affeoting earliest that portion surrounding tho acini. This new tissue 
ooaitraote, prodooing atrophy of the liver-oells, and olMrnotion of the 
vesMli and dnota. The organ, at litst enlarged and livid in oolonr, 
eowetimes gntdually ehanges into the hob-nailed liver, or into a 
shrunken imgslar mass, deformed by contracting bands. 

GivGU in doses loo wnall to affect iheatomach and livvr, pbo^iUorua 
modilics tho bones, capociatly in growing animals. Tims, whero 
BjiougA' tissae should bo formed in (he growing bone, dense solid 
tissue takee it« plaoo, which, examined by tho naked eye and iniero- 
seope, ia found to oonsist of woll-formed bono, und, if the adminis- 
^tralion of the phoephoma ia oontinned, the proportion of tlnuo bone 
incnaiWH, nnd tlic cancollonn stmctaro, in a^jconlanoe with a natural 



316 



pposPHOBCe. 



prooeM, becomci Blmrltcd to molco room for murow tbnw, till ■! 
lut DO cAotvllons strudtire ia l«ft, anil (tfivrwordii ihtt kuUil, newlT- 
formed Umue itmlt aha nndorgoes Bbsorptioa. Changes occor likt^ 
viae in tbo bony snbstkaee formed bjr llie perioatemn. The neirbaM 
look* natnntl, bnt ttio microecope reveals tliat it is dense, ami oo«i> 
pact nswce of it i-ucnncli on tbu Havcmiiui <»nftlR, proclnciag ii 
them at liuit It g«iicrftl narrowini; which aSecta evoD bona lanDcd 
previoiu to the admin Utration of (ifaottphonu. If |ibo«pkona i* 
givca for a tong time to adnit aniniala, iho spongy tissae thinfiTt^ 
and tlw oompaot tisma becom<!9i idill mam (Ivoav, and n.ft«r a tine 
new boDj tiunv is deposited on the inside of the ihnfl, increouinf tin 
tile hone actnatlj becomoH toltd. The chcmioal oompoHttioa of thr 
bone remaiiu natnral. 

Dr. yfegom found alio that under thu infioenoo of phosphonu. 
ailluK iift«r fracturva or reBeotion beeomes mora dense, and tJie tonaa- 
tion of new ueaeona tisHue in hxcmnd. 

Tbo changes above described are prodnoed by phosphom* aa snek, 
and noi after its convenion into phoKphorio acid. Por ptuwpbont 
acid doea not produce the peculiar chauj^it to tho stonincli and Unn 
It does, bowercr, alTcct the boitcM nimitarly, in vvrj large quantitii^ 
larger than ooulil he pnidnoed by the phosphoric acid generated tnm 
phosphorus inlrodncod into tho synloni. Wognor oonsidon tlMt it 
acU aa a food, promoting natural i;rawth. 

In acute poisoning, phosphorus itself is absorbed tuictiangad, b» 
in some cumts thi- hrrutb, the urine, and. after dt-oth, thu tbna 
tliemaelres, are luminous ; moreover, it has been ohcmiually (letwisJ 
in moat of the tiaanca. 

The jaundice occurring in aout« phospltoms poisoning has beta 
variously explained. T>r. Rbetain holiix that tt U not due to doilfW- 
tion of t)ioliv«r-c«lU.but to catarrh of the amallbilinry ducts, 
obtttruction and leading to abeorjrtion of the bile. Tho dnclni 
mnnis cliolodocns ha« somutimcii been found occladod bj a tenaeiHi 
pluj{ of mncoA, thus (fmtly assisting the ohatraolion of the anaU* 
ducts in the pnidnction of jaundice. Tho presence of bilinrr aeidt '» 
the urine, when jaundice oocnrs, certainly supporls tlio t-iew thai 
the jaundice depends on absorption from ubatraction of tbo dnaB, 
mther than from suppneMd secretion oning to the doatroBtioa W 
Ibe livcr-ci-llN. Sometimes the contents of the inteatinea an fosid 
destitute of bile. 

Acooiding to Mr. Asblntrton ThoinpHOD, the effects of tvpeswJ 
modicinat dcaea are improrvd appetite, increased rate of ciivnlatua. 
a hei^rhtened temperature, jicrnpimtion, irritation of the akin, 
dant urine, Kometimcs lonjk'd wiili lifpoiit, a sharpenini^ uf 
Ul foculties, increase of muscular poircr. a sonsation of wall' 



[^OSPHOBCS. 



317 



Bomotimos ncrvfJiiB cxciti^mcnt bHowd by hesitation nnd trembling 
(effects more readily iutluced in some permms tlinn in othera), ©von 
slight cloDio oonrnlsionB, occn«ionaUy some venereal ardonr, s.n<l, lom 
freqaentlj, a more ucute tactile asDsibilitj-. 

SoniotimeB, even nftor tloioM now CDit§i(lered modiotmiJ, M for 
inBtanoe ^ gr., ve get Rickness and jaundice wliicli mnj Uuit weeks or 
monthfl. The drug appcnnt to nft'oct come peraonii mncli more readily 
than otbere, and thtH unoertuiu notion, lung known, iisi'd to be 
ascribed to " idiosyncrasy." It has been assert«d that phosphoras in 
medicinal doses BOmetitncs canaes bmmatnria and ntbnminoiiK nrine, 
but this mnst bo annsnal, for having employed phoapliorUB in a 
vciy largo nnml>cr of cases, I linvu never sur^n this rcsnlL 

Phoaphoms has boon given lately in neuralgia with conaideiablo 
(tuccexd. It uppunrs to be effioaoioua in neuralgia of any part of the 
body. Some regard phosplioms U well nigh a specific. As might 
be expcdod. nhmnic cnses take longest to cnre, bat in all tlui inxtAn* 
ces sosceptible of benefit relief fblloirs the first few doues. Mr. 
Thornpson OEnployn 1a^gl^ doneti, giving nerer len tliiui onc'-twvntietb, 
and gonemlly one-twelfth, of a grain every throe bonra. Some writers 
think one-hundredth of a grain a HuiEciont doBo. 

The moat intmctable and scrore coses generally occur, as Dr. 
Anstie points out, in thu degeneration period of life ; but even in 
tlic*o imrtancon phosphoras may prove useful. My own experience 
hardly warrants mo in speaking no cnthiisiasiically of this drag m 
docs Mr. Thompson. Yet, though it not onoommonly tails in the 
Kcvere forms of neuralgia of middle and advanced life, still it most 
be considorotl ono of the moat valuable, perhaps the most valuable, 
remedy. In my hands it has yielded lea* sutii^factory rmitill« in 
sciatica than in many other forma of neuralgia. Phosphams is 
probably most olBcaeioaa in typical nonralgia, and much less nsofol. 
ftoi-cirding to my exptrionoc, iu those imperfectly-developed oases 
wbnrc the neuralgia appears to be allied to. or passes into, rick boad- 
iiche or pleurodynia, and in those instances of nerve pain which lack 
many of the more distinctive chanustora of neuralgia. Phosphoras 
is often nrviceable in angina pectoris, a disoaao closely allied to, if 
it be not a tme, neuralgia. 

I>r. Richard HnghM recommeDda phosphams tn chronic inflamma- 
tion of the rectnm, and Dr. Fleischmann. of Vienna, approves its use 
in pnonmoRtaf ospe^ally if aeoompanied by typhoid cymptoms. 

l)r. Bartbolow moommends pho^horns in wakcfniucss depending 
on centbra] annmia and in the wakefnlneu of the agn^. tt is useful 
in the degenerative changes due to age^ and under its use I bare 
seen many coses improve. Cod-liver oil, too, is beneficial in the same 
ca»ce and should bo given aimultaneotisly. 



316 



pacEpauBcs. 



1 



PhoKphonu ia uid to nliinnlntfi t!ia i!«xuil1 functions, and p«ti«alfl 
have told me, thnt tlicv wcro t^onetnunpd to clitoonllnne this Ang, 
bocauae it gavo them trouble iu tliU wuj'. Old mou, wliibit taking 
phoeplioroB, have told mo that it bad prodnced ft return of mxiuI 
cttpacitj. 

Mr. Thompaon eajs phoephoms. unless giTtm in }mtiio and iiBMft 
d(wo«, u noitlicir lui iipbrodiNinc nor tuMifnl in apormntorrhcMk, but tJmt 
in small tonio doses f\, to ^ f^. it will remove tbo pliysloal noil 
mcintnl ili-bilitj: indacnd hj HpermntorrUoM. A imege dnto, Thoiapsra 
i&jB, acts &A ft Btimalaut to tho brain, and fits it for nnuwial oxortiMl, 
and BO obviates pliykicnl and mental (ixhanstJon or <IcprceBioa 
overwork. 

Phosphoros is ccrtaiuljr niiefnl in over taxation of tho no: 
Eystem by too ardnons or too anxious work. In these patitnila 
power itt woakoned, tho mind aooo bocomei weai; and fntif'ued ; tiirj 
are irritable and depiesfled, and soicaal capacitj ia tnauy inHUuices is 
mnch impaired. Hers a prolooKed course of BsrenJ niontlts of 3^ Ib 
^ irrain thrico dail}* is often verj nsofnL It appears to pmmole 
tho nutrition of tlie nerrotia i^tenii 

llammonti commends phospborun in cerolnnl softening and ta 
hyxtcrioal panlTBts. and Aniriio in chrooio alcoholism, and Thompson 
recommends it stranffljr in mijfraine. 

Phosphorna is reoommondud in melancholia. Bartliolmv high); 
roeommends it in acno indnrata. 

It has been aswrted that phos[^onis 1079017 iacroMsa the i)iiantiti 
of nraa of tlio nrine, splittiuff up, tt is sud. the nitMgenoaa Iimum 
and converting lliein into fat nnd a com pound which nltiinatotj foreu 
nm; others hold that the fatty dt^Koneration is dno lo deftcJwt 
oxidation. Phoitphomx givce to tho nrino a smoU of viuleta or d 
sulphur. (See Turpootine.) 

Phosphide of sioo j^ gr. to ^ gr. doeos, has boun stmugly i«oo«n. 
moKUd- in place of phoephoma. In oompoundinir pho«phora> it 
mast not bu mixed with turpcntinr, ninco with tliis, and imlaUf 
with other easenlial oils, it oombinca and forma an inert oompovad; 
indeed, tnrpontine itself is ti«pit as an nntidoto in phoapltarai 
poisoning. Ilnlenherg and Gutlmunn point onl tliat witli & BolalteB 
of a copiwr-ttnlt phonphanm immediately forau a pboephide of oof- 
per, awl Uamborgcr'a experiments lend him to condade tKnt cnppvr 
xnltK urv far more efGciant antidotea than turpentine. Thu lalpbil* 
Iwing Kirougly emetio is eapeoiallj' nsefni. Tlin-v to five naint 
■honld bo given ovrrj five ininntes till vomiting ensaw. (Seo TSN 
pontine.) 

RrtI >iI|i>tro)>ic pIio»ipb"riis I'g inert. 

Tbu dixajfTiiMililu oruoltttious which occur when tukiug pbosphonu 






COUX>DI0X. 



31& 



uro doe la Uio oxidntioa of pUofiphorus, and th« liberation of bydro- 
tren, the noscettt giw nniling with phoi^phoiiis to form pboapliidu ©f 
hydrogen. 



COLLODION. 

CqUiODIOX is nNfnl in manj wnjrs. It m tued to Mljnst occnrntoly 
oad bind together tbo elites of cola and woandii, and to exclude air. 
It is eomotinuv npplicd to chujipcd liumU and L<bAp[iL>d nipple*; but 
for Lkeso affeotiont tliere are better applications, as glycerine of 
starch, arnica cerate, or two pnrta of cnn do Colognu to oDe of 
glycerine. For ubappi-d nipjikia, often bo difficult to hoal, equal 
pnrtH of RDlpharons acid and gljrcoriiin in a nsofol coin bi nation. 

Collodion, pointed over BU|>urficlal uiy^ipelas, elight buriw, or 
patches of hurpoM, before rraiclcfi aro dcvnbpvd, aubduo* inflammation, 
eoaes pain, and cbeclcK vuiiicatioa. Uiifortonatelj the collodion 
coating often cmcks, lulmilx air, and cciu;cs to bn vffioaciona; honce 
collodion is inferior to a Holutioii of nitnile of bHver in water or 
nitrous ctbcr. ( Vije Nitrate of Silver.) 

Ur. Uaro, we believe, fimt employed collodion for boiU. Thorv aro 
many kinds of boil*. Thu common form bogioii as a pimpio or puK- 
tulc, wbente llie inflammation spreads, producing a hard, painful 
owelling*, the cpntro of which dying forms a cow. Now if collodion 
in appliud at llm papular or pustular stage, the swelling nround tbo 
pustule Kubsidps, and tint furtliur development of the boil is anwgted 
in tlu> puKtular stage, collodion appearing to be nselcsa if the puKtula 
has burst. 1'ho matter muat not be let out afUtr tbo collodion appli- 
cation, or inflammation rocommoncev, aR<l tLo boil follows the nsnol 
course. It is dosimbto to ajiply fresh ooating« of co)lodion over the 
old ones, olloiring them to remain till the pustule boa driod up, and 
tha sore baa hoalod. If much pus aocumulatcd beneath this covering, 
caosing confiide ruble pain, the collodion should be incised under car- 
bolic acid, and the pus allowed to escape, the Hnhseqncnt treatment 
being conducted on Lister's carbolic acid plan. This trealmenl alUya 
the great irritAtion often accompanying the early stage* of boils. 
Dr. Uaro prefers the eontiactilo collodion, attributing ita miCDCBB 
munly to tbvprwBure it exerts. I liavo succeedt-d with Aoxihlo collo. 
dion, but perhaps the contractile wonid havo anNwurcI still bott«r.* 

* Tb« sxl«iuiaa sf a earbunalc^ ntsf •oDrtlnM b« liiuiM b; tighll; Mnip|iiDf villi 
(trip* ol tilbtilve ptutcr, apjilicd MnwbtriiMll; from ths bcniir ini*«rJj, uaniiil tod 
«i«r llis strellLii);. Dr. FUul highly nwommosili the >ppllaBlloD ei iniio untoicnt 
(one part «f «ilnM ni tmh >nu7a flowcn to Inn u( Uoaty) ipratd on duulirlon plaitcr 
na<I ptand OTtr tho bdl, th» >ppli«l)on Uiog rfncvcd oo«« or lirlra a ilijr. Be finds 
the latonwl uc of snios btatMsL 



320 



OILS. 



Some doctors add a drachm of spirit of tnipeatn* lo wtoli oonoo of 
collodion. 

Collodion eolations of gntta.poivbB, or iodia-rabber in obloroform 
pravcnt llu! ]>ilting of Mtnnll-pox, itnd tbo Sexiblu viaiotyot ooUodMO 
is bettor for thia purpose. 

A mixture of collodion and ciu-bolii; acid U noefal in toothncbe iae 
to an oxpOMod and inlltuncd palp. A jelly ia niftd« by meltinft ^ * 
test-tube some erjatalixed carbolic acid, thon ndding an cqaftl quan- 
tity of collodion. A portion of tJiia preparation on a small pioco of 
cotton-wool is inserted into tbo hollow painfnl tooth, with aorootiiDM 
oggmration of tlic pain, but in a few seconds it begins to diminidt 
and soon ceases. 

Coutmctilc collodion, with which Momo mix iodine, painted Ottt 
the inflamed part< in acute goni, will speedily relivTc tlie pais, 
ulthongfa for a brief npncc tlii) application incivaAoa it. Too ramr 
ooats must not be a]>plied, or the contraction is too geemt and dng- 
gjng on tbo skin, exciting a good deal of pun, or oven -proAatiog 
vesication. 

Sir U. Corrignn trc»t« the incontincnco of cbildrgo irith oollodiOB. 
The prepuce is drawn forward by tlie loft liaitd, and the littUi cap 
thus formed at ita extromity is smeared over with cotludion, wiuA 
DODtiading, draws closely together the edges of tlio prepoov, aaJ 
ttffoctnatly provciita the exit of urine. A fortnight of thin plat, 
which gives no pain and doos not prevent sleep, somotimiM miBBcM 
for the cure. Wbun it ia novdfal to pass water, the liltio cap li 
collodion can be easily chipped off with the nail. Tho prei>aoe in Uw 
morning is foand distended with urine. Sir D. Corrigan thinks tbi 
it woiuld answer as well to paiut the ooUodion orcr th« oriSoe of Ik 
nretiiim. This plan I find unHuitablo for girls, as it exoitea sinartiw, 
and induces tbeiu to piulc oH tlie colludiou. 

Two parta of glyccnoo lo a hundred parts of coUodioD avt« witlrtil 
contraoling or dragging the skin. 



COD-LIVEB OIL. 
ALSIOND OIL. 
POPPY OIL 
HEMP.SEED OIL 
LINSKEO OIL. 
COCOA-NTT OIL. 



DUGONG OH. 

PALM OIL. 

LAKO. 

SORT. 

WAX. 

Etc. 



Vats, in one form or other, am found abundantly in both tbo ti r!«-*l 
and vtgotaUe kingdoms, showing their great importottce ia umnir 
life. 



oits. 



321 



Fats nro necBHear]: fooiU to tho aniiual body, being hcftt-givin^, 
foTRc-mpplyu)^, and pla«tio. Their oombustion oontributas mainlj 
to the generation of tho liont of the bndy. They aro oemmtinl to 
tissno-fonnnttan. for without thorn nulrition and growth would ba 
very imperfect, if not imi>(m)iibh>. 

Thpir combnutiou, moroover, Bnpplies most of tho force appro- 
printt'il by tha nitrofiunaua atriictnTM. and tliroiigh them to be con- 
Torlcd into moMular force, sccrctivo forcp, nerve force, etc. 

For the most part, all tat*, mo far tm wv knon-, have the same phj. 
eical proportiem dilforinK only in the meltin}:; point. In their cbomi. 
cal nature, however, they ililfor much, but iifter entering the blood 
they aro probably converted into a fat of uniform compoHition. 

Oila and fatd are used to Inbricato and to Buppio the fikin when ifc 
has loat itH elasticity, and becomes dry, bard, and liahlo to crack ; 
for instance, in many acaly diacasos, aa psoriaaU and xeroderma. 
They ahoald bo employed in conjunction with warm baths. 

Fat^ moreover, nro applied to tho f urfaoo of the body to prevent 
irritation from euch oxcruta an urine or f»ce«, or by acrid diMchargcA, 
as in eczema, and when need for this pi-otectivo purpose, some atimu- 
hting suhstance, a« oxidu of cine, ia generally incorporated with 
them. 

Simple oiU aro nxed to soften and facilitate tho removal of acabt, 
&« of impetigo, ecxeina, and favos. Pooltices are likewise uHeful in 
favuR preparatory to epilation. 

Oils are eometimea, with occnaional success, rubbed into the akin 
of the whole aurfncc, to prevent tho ilehiiitatinE; awcating acoom- 
panying esbauBting diseaaoe, as plithiaiii; but this prooesa ih ioftirior 
to that of itpiinging the nkin with a weak acid muth, and to other 
moana. With the ancient Hnmau^ during the doclino, when warm 
baths were so much indul^d in, it was the custom to anoint the 
body with fata, to check tho profnso sweating caoaed by this enor- 
vatinft liabit. 

Fata nro aomeiimcs mblwd into tha skin with a view to their 
ahttorplion, so as to minister to the nutrition of tbu body. 

Fats and oila are in general oac as oxcipionts for the application of 
various ageota to tlie skin. 

Il boa beon Rsscrt«d that the inunction of the body with fatty 
snb»tanOM will induce a conaidetahio full in its temperature ; but 
in a solitary testing instance I fonnd this statement to bo incorrect. 

Rubbing the hands and feet with aomo 8nn fat will remove tho 
irksome scnantion of heat and tightness produced by the raehea of 
scarlet fever or measles. 

Some piactitioncr* trent scnrlntina solely by inunctions, anointinf^ 
thoroughly the skin of the whole bcdy twice or tJiree times a day 



822 



OILS. 



with a hlaad fat, or oil, wliicli is not to Iw wiped off during earn- 
-valowcnco from ecarlatina. Dr. Badd, of Bristol, recommends the 
inundion of oil ; the jiaticnt tolcM n bnth nt nif^Iit, nod niter^ bai>(C 
wiped qnito dry, ii bJnnd oil, ]ik« ftlmond oil, is mbb«<l ovtr tha 
Tbole Iwdj:. Tbi* Irmtmctnt in nnid to lUisiKt dctqaunntion, and to 
prevent scqcolv : moreover, it probably lessens tlie risk of (-xinto^on 
by preventing tho iliffnsion of tbo branny particles of the skin bj 
cnrreuts of «ir. 

In cnws of rinf^orm, it is a uscfnl practice to prevent the Bxtan- 
sion of tho diseaso by grciMin)); tho head wrj fru*?!? to hinder th» 
•pomlcit r»kvbing the unafteL-ted hair, llic tuKontAininntfid mom- 
bera of tho family bIioqM also neo prease to tite hair treo\y (or 
tho Mune parposc, And probably it wonld Iw more provcntire to 
ose a mild marcurial pomade, or quinine dissolved in glvcvriiM', 
»a that the sporalos may alight on some xtibstanco dostmotire to 
them. 

Oils and fat« arc not nsod topically in diseases of tho month, eor 
do fats nndcrtro alteration in lliis cavity, and they aro nlmost as 
little aiTectod in tlio stomach. If oncloeod in albnminoua wnlU, as 
in the fbnn of ool], these being disHolved, Ihe fat is set free. Al- 
thotti^h thcmnclvcs not acted npon by tho Gtotaach. fntA, howervrt ao* 
npon tlte ollior forms of food : ihci,- ccrlnlnty promote tho femiMila- 
tion of sn^r and starch ; and it isgenorally neciiptrd that hte, bj 
assiating tboxc chemical clutagcs which coDxtitotc difp^mtioQ, aid tho 
coavoTsion of tho nitrogcnoBs food. For example, fat* nsmat the 
fermenlatino of milk, and promote tho proctm of artificial digt» 
tion; and this action of fats npon food can be dcmonatnled 
ontside the body. Bat hriw futK (■fF<'ct tiifJto chanf^H. und whrlhvr, 
at the mmo limo, thoy thcmsolTcs arc in any measuro moditlsd 
is constitution, are questions at present <)nilo nnnottled. The 
iM|i O rtM ioe of this proptrly of fats mnet be snfBcicntly appntmt, 
asd needs no farther comment. In lar;^ qttnnlitic-ii ther hiniler 
di^Htion. jKiRiiibly by their decomposition, and tho formation of aeidi 
foreign to the stomach. 

Fats ondergo a yariety of chanf^es in the intestines ; amoo}; other* 
tltey are ab*orbnl lioth by tlic lacteals and veins, but it in atill an 
an(tocidc<l question how this process is effected. 

Tho alkaline panorcatic jnico omnlKioniics fat«, and iu this cm- 
dition tbcir absorption is sapposed to be facilitated ; but it i* 
difBcnlt to nnderstand liow more division slionld anjiist thoir paa- 
taire from tim iutcsliues to the binod : further, it is mnintaJoMl 
that when tho pancrmtic dnct is tied, animals remain on ftit a* 
before. 

tt has been lunnised that fat may become ssponifiod. and so ptm 



I 



4 

I 



ons. 



323 



tbroTiflrh tho walls of the intc«tinej) into the blood, and prohnbly * 
small pnrt does pass iuto Iha oircnlation in this form ; but. ns ranch 
unmponiGod fiit ih viKiblc in ttut epithulium coIIn <N3rcrin^ tho villi, 
nnd much c&n bo extracted from the chyle, the chief part muBt un- 
dergo abnorption in anotlinr niiiniutr. 

The posuifte of fitts thi-oogh ihi> moiflt amm&l membranea taemiag 
tho int««tinitl cnnni, is probably justly nsoribud to tbu mAaoa oi the 
bile; and in aupjKirt of this propoaition. apart from other evidence 
ponBible tf tulduco, it idat be ndriinccd tlmt — 

I. la capillary labos muistc'ned with vrater, fats rise scaraoly At 
oil ; bnt if tho tabes aiv moistcnod witli bilo the fats rise from twelve 
to fODrteen timus higbL-r. 

II. While fats pass v,-ith oxtromo diOicnlty through moist, aniBwl 
membranes, if tbvso are rooittloned irith bilo tbu fain, on may be 
flbnwn ex pcritnra tally, puss rMulily. 

Fats pass, to a small extent, into tho blood by tlie agency of tho 
intestinal juice. 

The chitiF part of tho fat pofwSK into the lactonlii ; a liltlo intn the 
veiua, to be conveyed to the liver, there to be converted into ebolio 
ai3i(l 1 or, at least, it is prohalilo that the oleic acid andorfcoca thin 
change. The cliolic acid, uniting with the soda set free when the 
hydroeh]i>ric iu''u\ of tho Rn«trio jnEoo is poured into tho intfstinvc, 
forms a kind of soap, namely, tbo tanrocbolate and glycoeholate of 
soda. Tbdio agnin Itnd their way into the intestines, tutd after 
serving their deetined purjiose there, tho base rennites with the acid 
of the gHHtric jnico from which it boM been s^arated. 

The inflncnoe of fats on the secrotton of bile varies aooordinjif to 
circnmstanoos ; if talcpn on an empty Momnch, fats lessen the bitiftry 
secretion ; if taken with, or after food, they increase it. 

As food greatly nngmontd tho How of bile, wo haro hero an indi- 
cation, abundantly corrobomted by experience, to give fats oitbcr 
with or noon after n meal. 

The melltni;; point of « btt mnst influence its absorption ; for if 
this point is nlmvo the tempomtnre of the iKxIy, tlie tui, tmless di»- 
solved in the more liqneflable fats, mnst remain unabsorbed. 

The iitoniach tolerates animal far hotter thnn ve^tablo fats ; more- 
over, nniual hts may bo ^ven in larger doaw, and for a longer time ; 
oircDmittancc* which, in some mcosniea, explain the medicinal supe- 
riority of animal over Tcgotable fats. 

There is a limit to the ([nantity of fats ahitorbable by the body. 
In TCftard to cod. liver nil, at fii-st only a email qnauti^ is (nkcn up, 
and often for some w<«ks some of it appears in tbo motions ; how- 
ever, more and more of it becomes absorbed, till fnll doses are borne, 
and find entnmce into tlio circulation ; but in too large « (|aantity 

T 2 



324 



0II.5. 



tliM oil IB ViMe to ilecompoee, &nd to fonn bortfnl acids, excitiag 
muBes. vomiting, colic, and diArrliaa. Thia limiutioa to tlio qoKntitjr 
kiswrbed as well as tbe irritation caoBcd by an excfsB remsiiitnif to 
tlM int«atinMi are saScimt txtuonii, to nay notltin); of ccnnomj-, to 
make it nndesirnble to give more bt than can be appropriatod. Too 
large a dose ta both wastvfal and liarmfal. By oxniuinittg the 
raotioDM da; bj daj vre oaa ab anj time Baoertain if too rnnob is 
adninietcrrd. 

Calan-Ii of the iut««tin«« is a oonditioa nnfavoamhle to the sb- 
sorptioB of fat. Oils are Bomotinm given aft^r a potsonoos doM of 
a ooRoaire auhstaiice, vrith the inteDlion of forming a protective 
sheathing to Iho mucons mcmbtane. bnt it is impossible to giro a 
ooatiDg of oO to a menWaae noUteoed irith wat«r. Cod-liver oil 
BonwtimM overcomoa obstioatc habttoal coostipaiton in cbildron. 
Figs Icopt ID Lnoca oil and one or two eaten daily are gemtlj 
relaxing. 

Fat is speedily sapoiillied in the laoteab and blood-resaels, and 
moat of it in the blood-vMselfl appears to colI«;t in tho blood- 
corpuscles, and may coDtribote to their formation, gmn-th, Jc«. 

Fats, as we have said, uro bcat-giving, forc«-Happlying, » n4 
plastic. In common with other oombastibli! mbxtancce, they, 
through oxidation, uphold the tvmporature of the body. This, tbon^ 
an imporlnnt, is not their only, nor tlieir most valuable, fnnclion. 

Fats, like phosphate of lime, aro neomaary both to growth aad 
nutrition ; for in the moat vitally -endowed organs fala are found In 
ezMM, and abound wherever ccll-f^rovrth proceeds r»pidly ; it 
abonods oven in disensc, fur mach fat is fonnd in fast-growiug 
cancer; it is found, moreover, asBociatod with the more highly-organ- 
ised conatitaonls. Thus tho fat existing in pas is chiefly iLssoci&t«d 
with the corpuacles, comparatively little being fonnd in tbe sarom. 
More fat is found in plastic thnn in non-plastic formations ; in 4^| 
obaervations day bv dny di.-Rii>nstrato more and moro the importawV 
of fats as tiasae-forming substances. Pacta like thwe obviously b«r 
OB the osc of the members of this group in disoaso ; but to thta 
subject we shall return shortly. 

ObMrrations ti.-nd to *how that fata are force-yiclding Bnbataoraa, 
and that tbe )>ecDliar forces of tbe Ix'dy are mainly derived fra«a 
the fata we consume. Only a abort time ago it was considend thai 
the forcM of the body were derived from the oorabusltoa of tba 
nitgrageomu Btnultuw, but many Dirunmstances t«U ooaoltuiW* 
against this hypolbeaia. JB 

). Aft*t m^m aoi) pnknttd «iwdi^ the srta tt ihs srioa ii Man*}; Inrnswit ; 
sea u tbl* MlsUKa h s Bmon of tb« wasaoiplkia «l aUrgpaoat msMiali, it fbUves 
tksl Kt neb liaM \M lUth •! Il 1) eoB(n»«J. 



OILS. 



3-25 



£. [Toiler txertun, HwrniaD* qnuititica of oarbonio uld *ra cibilid from tht longi, 
pobtioK iodubiUl>l]r to lb* ooDbnation of Mrbo-lijvLnl«^ or ol UHj mUUDCM, lb« 
una nt tb« uiiii« time buI being !ncriM»Ml. 

3. Tbo eombiutina ocMun oliicilf, not in tbe blind, bnl to lbs muwlei tbtniKlTaa, for 
vh«n the** are ««)>tnt«d (n>ia ilic boJ/, and iniule lo oonltut anJer * b«l]-Elu*. lb«r 
■r* touod to field, doiiDg the tine of tliolr tclSrltj, an eaoroioiu quntili- d( rarbonio 
ncld. 

4. II bu b«» found b; ujiorEmenl tbat wbcn onlj *larchj an^l taitjr loodi ue mten, 
great tictUan and pralengeil luboar oaa be ouduttd, while at tbe nam time the area ol 
tbo uiioe U but lilllo iaoreM«rl. 

Drs. Cutler rucI Brwdforil, uaing Mulaaitcz'a inbthod of counting 
tbo red corpuscluM, Gml thiit in health cod-liver oil cnnetis an incrcn«o 
in tJie uomber of rod corpusutea, and a alight IncreMe in the wliito. 

T)r. John Dity's (of Qoebng) ingenioas experimont:! show thnt fat* 
poiiaiMui voaaidfimble power in courerliiig oxyi^'u into [ieiroiii]e of 
hjdrogun ; nlso that tho colouring mntt«r of tbo blood tapidljr dgcom- 
poHea thia into water. Mid rnuoont oxygen with ila charact«riatic 
activD [irujttirttM ; and ho soggesta that fate may piny this importnnt 
part ill tho blood, tnnkin)^ inert oxygon of thu utmospboro into aotive 
oxygen. Hla experiments show tbat the iron of the colonring nuttor 
of tho blood is ])ral)ab1y tliu agent deoompotting the peroxide of 
hydrogen. Ether alao posaeasM (Treat power to form oxygon into 
peroxide of hydrogen ; uud Dr. IMy suggi;Kl(( that the otQuacy of 
cthorizod cod-ltvcr oil may be due to the large qiuuitity of peroxide 
of hydrogen it contains. 

Fata being nocossacy to growth, natrition, and tlie doe performance 
of the bodily fnnctions, are poculiitrly suited to conraleneentdi from 
acute general diseasee. Fata ore also useful in many chronic affec- 
tions. On the iiiibti<lonco of many acute infliimnuitionit, lu of the 
kidneys, heart, or luuga, u chnmic, but not less falel, condition may 
bo Mt, a condition the danger of which is in proportion to the health 
of tho patient previous to the aont« atUwk. If th« patient's licalth 
bus been inipovoriMbod, or if ho is the subject of tuberenlosia, or of 
BcrofnU, niiiny aei|uelie are apt to oocnr. Middle-iLgod and old 
peopl«, in whom tlie nutritive prooeu begins to flag, ore moro liable 
to obronic diaeaMS after ocutc attack. A liko danger threatens 
children whoso previous health has been domagMl by unhygieniu 
conditions. It beuefits the chrenio degenerative diseased of old age. 
Tbeee and oth«r ntolodiea depend on deficient nutrition, and, aa fata 
ore peculiarly promolera of thia function, tbey are specially tidefnl 
in such chrooio taalodiea. 

Tho depondenoe of ehronio olfectious on tho state of geneml natri- 
tion may be shown in another way. Ponons are fonnd to suffer from 
IKHD* slight toool nfFection, but little troableeome while the health is 
unbroken, but as the weakest link of tbo chain is tbo Grst to yield. 



32G 



01L3. 



80, if the hoftllU giva w&jr, tb» Ioca) mischutf beooniM immediatdy 
dcToloped or af^rarated. Thtu nuaj tndiriditBla are aUe to measare 
tke stata of tboir gvncral hcaltli bjr tho condition of a local diaeaas. 
Here, again, aa; tr«atiueDt tvstorative o( tli« gvnvral liealtJ] will 
rodaco the local affection to its former Qsiinportaat Btnt«, and in saob 
a COM ood-liver oU la otUM indicntcd. 

ThuH «xpene<noo confirms the eCBcacf of ood-liver oil in tnanf 
chronic inflammnliiwM, m of tho heui, Ivtng^ and kidntsj):, and in 
the neqnvln of the acut« bpeciflo di nea ae c , as the i-iirunic dihcUar)^ 
from tha ears or doso m> often loft hy acarlet favcr or mcaskoa. 

Cod-liver oil is of special non'ice in iicrafula, tenxlin;; to rvmon 
tlie variona manifoctatioDs of this disnue, as chronic dtschargv trota 
the front and noiie, stmmona ophthalmia, atramoaa dJaeaae of Um 
bonos, Btrumons ahscessefi, Ac 

In the treatment of phthtfds ood-livor oil Htauds pre-emiiLeBt. 
The lenn phthisis, howerer, indtideii several distinct discaseK. For 
onr pnrpoEo it is sufHcicnt hero to dividu thetn into Ihu fcbrito and 
non-folirile varietiea; — thoeo forma monifestiiig pretematuml heal 
of tho bodfi and those in which the temperature is natnml, or riaea 
only OL-cuionutl}', and for a kIiofc time. The exifttence of fuver in 
tho fobrilo forms of phthisis is by no means an indication nf the use- 
leasness or hannfnlneea of cod-livur oil, for in lliin condition tauiy 
patients dariro conBtdersbl« benefit from ic. In tliis form ui 
phthixia, as, indeed, in all oasea, we mnst be gDi<le(], in tho oa»pl4^ 
inent of this reinedjrt not onljr by the natnre of the diMaae, Imt also 
by tius state of the patient in other rvuprcts. If the digoetiun ta 
good, cod-lirer oil may gcncmlly Iw given with odvantAge, but t( 
the stomach is irritable, then ood-Uvcr oil does harm bjr still fortlHir 
disordering it. 

In the chronic, or non-febrile forma of phtliiais, cod-livor oil ia 
genenllf well homo, and does great good ; bnt, as with tin* morr 
acute Tarietiea, it sometimvM upnulo tiw nUimt\iOh. It in gitiifimllr 
held that diarrlicDa in phthisis is a decisive indication against the 
employment of the oil ; but tltis iti only parity true. Cod-livor oil, 
BO doubt. sometinHS increases diarrfacra, bnt this chiofly nrijNM wluoi, 
the doao ia nndnly large, or too freqmiitly atlministercd ; it oalj^ 
teaapooufnl ia given at a dose once or twice a day, the oil ofteii mH 
eonlmU diarrhoea. In cases of phthisis with diarrfaaa, it !a k good 
plan to begin the cod>liver oil with cnntionitly small doanM, and if it 
Kuita it may be gircn with greater freedom. An oxcclloDt motliod is 
to give a teaapoo&fnl tlio last thing at night, immediately Iwfon 
sleep, when it mar often bo borne without prodncing either naBsoi 
or diarrhoea, thongfa prerionsl; it had oocasioncd odo or both of 
tlMta ajnqitani. 



OILS. 



327 



In the early tttnge, tt% nuf^bt bo oxpocted, phUiutui i* most bonofitod 
hf tim unc of oils. 

rhlegmatio pcrRons n-ith salloir skins and dark comploEinnM, 
iKrDclit more, it U mid, bj cod-livor oil tbiin [lerwrins of s&D^iun6 
temiwmnumt and florid complesiou. 

Cod-liver oil U often very Honiccablo in chronic rhonmfttigm, 
rlienmntoid uiin-itis. cbranic gont, chronic skin affections, t^hilitic 
or otberwiRe. It ik also jiarticulikrlT UHcfiil in inn]>byM.in& of tlie 
lungs, and obronic bronchitig ; in the former checking long dogonoro- 
tioD. in the latter contrullin^ expootoration. 

Mnnjr persons, pspccintlj' tlu agod, complain of oiuch sinking, or a 
BOnsation of "omving" at the epigastrinm, relieved for a abort tinw 
tmly hy food, a condition somotimes oonnecUil with atoaio dyspepsia, 
souetimcM ditjiendimt on tho genonil stato of kuallli. If the iutcs- 
tinnl canal is not in an irritablo condition, cod-liror oil will raniBdj 
thi* ainking. Uiddto>agod pationtk snSuring from that aiioroulous 
group of symptoms called hysteria, somBtimes complain of the sama 
irlcaonw aymptonu. In ihia cane oil will rumove the niuking, while 
it oft«a mmultaaoouslj- relicroa tho other symjitoms of the group. 

Cod-liver oil and c|u{niuo i« tli« buHt trciitmvnt for giddioMs in tha 
ngcd, that is, when this symptom is not aacribnble to sorioua organio 
brain diaeate, but probably to athoromatona chutgo* in the hniin- 
Tusola, or to a weak heart. Indeed cod-liver oil, ^iuee it promotes 
nutrition, ts highly uaelul in ihu suSering duo to old age. 

Fftta aro of apecial oae in the chronic dieenses of cbUdron, arising 
from mal'uutriliou, and any local malady will generally disappear <in 
restoring nntrition and growth to tbo hoolthy stat«. 

Cod-livor oil often favounkhly niodilliM the course of Inryngismoa 
atridnttis, rickets, chorea, the middle and after slago of whooping- 
oougli, and chronic couglia. 

Iho obstinate eonstipation of children sometimes yields to cod- 
liver oil. 

Thu chronio diarrhoea of a few ]iale, stinking, pnlpy motiona diuly 
will rodaoe a child n few montlis old alniost U> a skeleton. Tho skin 
boeomea leathery and wrinkled, food is. perhaps, rejected, and, when 
brought to iliia dangemns paaa, thrush bivaks out. While combating 
tho diairhon or vomiting, a tcnspooufnl or half a teaspoonful of cod- 
liver oil, given U> the child nightly before sloep, gradnalty increasing 
tho quantity and frvqncncgr of tho doac, will neither inoreaM the 
romiting nor the dtarrluaa, but, on tho oontrary, will promote 
nourishment, growth, improve the gvnend hoaltli, and raoao the 
patient from a perilona condition. 

Hitherto, fats have been Kpokcn of, for the most part, in common, 
but tb^ certainly are not all equally useful therapeutic ageiita. 



328 



OILS. 



An we h^ve seen, aniDoa] isxts ura to be preferred to Togetablo bU; 
and livor fats ar» generally esteemed brj-ond all others. Wbetlier 
cod-liver oil ia BDperior to thai di-rivcd from tliu lirera of otllH 
aoinialit is ilifGcnll to decide — since mucli of the cod-liver oil ^| 
Dommcrou ut procured, not only from the livers of vkrious Itsh, but 
likowiso, it is said, from those of other marine animals. 

The superiority of cod-liver oil has kcx-n thought to dopond on tlut 
minute qnantitiM of iodioe, phosphoros, or bile it contains—* ooo- 
jeoture dearly wrou)*. for the eSecl of thcao ntbetances in iTJiw 
ia diuimilar to thtit of the oil. 

The superiority of Uver uils is aKrtbablo to their easy tolerktioo 
by the stomEu^h. Tbey genof'nlly can be taken wilbont incoavnunuo 
for montbit or j'cars, while other fnts and oiU ofltax prodnce nanso, 
lofis of appetite, and dian-hcea. There is mson to think tbat cod- 
liver oil i« more easily absorbctl than otlior oiU- 

Cod-liver oil, at lirst, often excites nausea, vomiting, and d» 
ngrccablo cmctalionit. OccuNionnlly, the dilGculiy in overcoming the 
diatotite for this medicine is almost insuperable; yet diitgast ia gea^ 
rally overcome, and in a, rhiirt time the oil is inkon even with roK&h, 
nod children, indeed, often come to regard it us a treat. SomeUnui^ 
at tho commencement of tho coaree, a child bccomee languid, appo- 
titeleui, and appears none; but usunlly, alter a vreek or teu days 
tho oil begins to bo tolerated, and then improvement seta in. 

The nanaea and vomiting sometimeM cauKd by this remedy may be 
produced by too largo a dose. At first n teaspoonfnl only, or ewn 
leiiS, is enough ; aiid sliould the stomaeli uianifnit intolonooo, one 
dose only should bo given daily ; and it is a good practice to girti ii 
at night-time, just before lying down to sleep. 

Cod-liver oil is often admiuiatercd in sooh quantities that it can 
(carcety be boroe, even when the stomach in necnstomed to it. 
Weeks, and even months may eJapae, befora full doses of oil can be 
iligmtvd nud absorbed ; huoce, if Bwallon-od in nndoo bulk, it merolr 
|iaMM oft by the motioaa, and by its decompoaitioB is liable to ilia* 
order tho intestines. An examination of the motioua will show 
whether tho oil is given in excess. 

Cod-liver oil should be taken after food, on orange^ or ginger.wino, 
or weak brsndy-and-vtater, or somo agrccublc tinctnro of orange-t>e«|, 
and should be so poured as rot to loach tlic glass, but to flo«i on 
tho aarfaco of the wine or the brandy as a globule, and thus tiKworl 
oil. A little mil taken immediately Ifcforo ami after tho doao ofloa 
removes tho laxte, snd prevents nausea, and it ia said that a few drops 
of kulchnp nitded to the oil will cover itH tttsto. 

A mixture composed of equal parts of cod-liror oil and frosh 
mBcihtge of gam acacia and water, has very little taste, and the adJi- 



(ML8. 



329 



lion of two DiiDiins of oil of lemons to oncli onnoo of this mixture 
effectaally conceals the finhy Haroar. 

A ro(l-liv<T oil jHly has recently been propitred, which is said to 
contain "0 per cent, of (n'l. Butt«d liku jelly it is almost taatuluM. 

NotwithstAnrling such iD^cnions deTic«e, it is not uncommon to 
mei>t with patieota ivho, urun after repeated trials, cannot tolerftte 
the oil on accotint of tbo oractations, loaa of appctitv, nausea, or 
vomiting. In .lome case* this intolomncc is duo to dyftpepsia ; but it 
is gcnvrally do© to that inability to diRest and absorb fat, so com- 
monly notiood in consnmptJon, oven boforo ita development. This 
fact has been mnoh dvrelt on by Dr. Oaltbasar Fostor, who, led by 
som« snggMtire cxporiment« of Claudo Bernard — in the cnso of 
patients intolerant of oil, asoa ether as a means of assisting the 
(ItgcstioD and absorption of fat. 

Claade Bernard has shown that the action of other " is twofold — 
(I) it etimnlatca the pancreas and glands of the daodcnum to pour 
out thoir eecrctiona freely, and (£) at tho same! tJoie facilitates the 
absorption of thoso very substances which these secretions atv dc< 
signed to dif^t. In other words, eUicr not only obtains for ns tho 
sooretions required to digest, but promotes the absorption of tfa«es 
fats when digested." Bernard maintains that fats tue chiefly ab- 
sorbed by mcikns of those secretions. After a prolonged investigation 
of the inflneoes of etlier. Dr. Balthaxar FoKler finds that oils and 
fat«, which othorwlso causo nausea and sickness, are, by means of 
this combination, retained nnd digested, thus incrensing ajipetite, 
nutrition, and weight. Dr. Ii'oster employs elhcr purus of tlie I'har- 
mncopcDin in doses of from ton to fifteen minima to every two 
drachma of oil. The ether may he given either nepnintoty, or with 
tho oil ; hut ns tbo ether masks tbo nnsnvoariiiess of th« oil, it is 
better to combine them. 

Lime-wator mixed with tho oil sometimes obviates nausea, and 
even diarrhoea. 

Pats ar« consumed in the body, but sometimes a small <iuantity 
escapes with the fnoes and arine. Tho quantity escaping by the 
urino is insignificant, except in tbo disease called chylous urine, 
when fat is often present in considerable amount. In Bright's 
disease, a little tai ia voided with tbo nriniforous oasts in tho 
nrinek 



sso 



oris. 



CASTOR OIL, CROTON OIL. 



Thbsb oil* oonsist of A blnnd oil, with a rnrinble qnsntity of an Mcrid, 
imtetiDg, par^tive matter, which imparts to tViem tlioir c1inrBcton»- 
tia propertiL-n. ^'his irritating gubtitiiiii.'o I'xUtii iti « viuull )(ro[><>rtioD 
in castor oil, and in a larfrer degree in croton oil. Crotoa oil irrilatea 
tiie alun, prodacat rcdnoH, vesiontion, nm), with a ktronfc applicatjoa, 
oven pnstulntion, followed bj acan. The irritntin^ cSoct ia inereued 
b_T thi^ udniixturo of nlknlios ; limco-, liquor potatwe i» fiometJiaM 
ndilrnl, to intcngifj the elTfL-ta of L-ruton oil. 

Ita actbn in votj varikblc ; aercral npplioationa on snocetsiro Atya 
may produce but ^ght vesieallon, whilHi fiometimee * single moder- 
ate application sets np grant irrilution, muolt Toaicnttion, mmI ona 
pojttal&tion. Caatiou in therefore newUul. When applied too •aer^ 
Reticallj- or too porsistontiy, croton oil liniment iH>nu)timos prodnoea 
Guperllcial luipillifonn white ruuud auun, with a hair foUicIo io tke 
cuntre. Those scars gmdnatly disappear. Croton oil liniment ap. 
plied to tht! ohust of phthiKical and brunchitic patientn. iii bigUlj- 
Mloomed as a counter-irriiaot, bnt, owing to the vouuition it pro- 
daoes, it cannot generally bo repeated more than once or twi4W «■ 
K»cct««v« d»3rs. and sometimes only one application cmi be bursa. 
In bronohitia and phthisis, croton oil liniment is aonwtimes prafeirad 
to BiBstard ponlticee, and, indeed, certain pntioats aver thai oraloB 
oil ((iveii them greater rt^liuf than mii^tanl poultices. Tlie vosicaUoai 
being a decided disadvantage, the patiuut must oarafally avoid ooe- 
veyiiig tiny of the croton ajiplication t« tender porta of the skin, leal 
it ebould provoke troublmomu or Mvere iuflammation of thu tmix ur 
aerotnm. Dr. Tilbur}- Fos states, that crotoa oil sumetinies prodaOM 
a symmetrical erythema nf the face, lasting for a few daye, where M 
dtract application of the drug ooald hare occurred ; and 1 too bawi 
seen tbiM erythema of the face ooonr during the entploymout af| 
tiTDton oil. It is hard to say whether this orj'thumn doponda on tli* 
action of the croton oil after ita abaorption into Iho blood, or on the 
volatile nrrid principle, reaching the face tbroagh the air, or by 
of the honda. 

Aa is the case somotiuea with iodine liniment, and now tutd tliaa 
from a belladonna plast«r, I linve known croton oil liniment prodaee 
a crop of itching papulcH which have spread over the chief paitof tba | 
body, reaching oven to the feet. 

Dr. Abler Sniitb employs orolon oil as an application in obstuMla 
ringKomi, Ho says, " t gonerally pat it on a patch about the ^m of 
n ihilliag, with a Munll mtners hair bruxh, and order a poultic« to be 
ftppliod at night, then, if it has not sot np severe infiummatioa and 



OILS. 



SSI 



pustolation by tho next t)»T, which is voiy rorc, 1 npplj >t Kgnm, 
kuuping poulticeti on vnnnttuitly Auy nnd nlf^bt. A pustnlAr nish 
occurs at onco, bat tho oil can bo npptit^d over this, anil n doilj: A])pli* 
oatioa of it for three, six, or ten dny*. Uigrthur with constant bath> 
ing with warm wnior, noil froqttdnt ponltieing with liQMod moftl, will 
}{en6rally set up sacb iuflaniEaatorjr cxudatiou, Umt tlio patch resem- 
blo8 troo korion." 

Pure castor oil is almost ta3t«le«s. Croton oil hu an acrid bomiBf; 
taste. 

Thme oils, apart fnim thdr acrid principle, bcbnvo Id the Mtomncb 
nod intestines, for the most part, like other oils. Croton oil in a 
large dose inflaniUH tlic Mtorauch. If not qniokl; «xpollud from the 
inXmAiam, thej become absorbed into the blood, and serve tJie samu 
porpoKs OS other oilit. 

Tho aorid matter of these oils, irritating the mueoiu membrane 
of the intoBtinc, cxcitos slight catarrh, and b_v this mains purges. 
As alkalios iot^insifjr the aotion of tho nerid principle, the purgative 
cITcct of those oils is heightened bj admixture with the alkali of the 
bile. 

These oils, especially castor oil, are common]]' used as purgatives. 
Ciwtor oil is a spoedj, certain, and somewhat mild purgative, pro. 
dnoing only one, two, or three motions, with little griping. It is 
Nkid to purge when injeeted into the veins, or even when applied 
to tho skin : and if this stalomotit is true, the oil must have an 
c«pceiul affinity for the int«BtincB. It is commonly used as a purga- 
tive for children, women with child, aftor jmrlnrition, in fever, pilce, 
and fiunre of thct anuK. It is not n good piirj^livo in habitual con- 
stipation, as it increasea the torpid babit of tho bowels, an effect 
constantly w!tne»ed in children. 

CrotMi oil is a powerful purgative, producing wat«ry stoola, with 
niTich depronxion. It is an uncertain puri,'ative, sometimes acting in 
half an hour, at other time* ruqniring much longer; largo quantities, 
even six or eight drops, may be required ; hence it is seldom used, 
unless, as in apoplexy, ooma, and mania, wltcn it is important lo 
administer a purgative of small balk. It is sometimcis employed in 
obstinate comrttpation when other purgatives ha\-o failed. It is a 
good plan to give a quarter or a third uf a minim every hour, by 
which means a much small<Tr total qniintity often sqccoc<1k bettor than 
a larger ()aanlity given in one dose- Owing to its acrid taste, it is 
generality administered in the form of n pill, except to patients in a 
atate of insensibility, whon it is mixed with a little butter or lartl, 
and conveyed to tho back of the tongno, and is swallowed iovoliiD- 
tarity, or trioklea down tho throat. 

Roliri^, from experimental evidence, is led to conclads (hat 



332 



oae. 



I 




croton oil f^ven to faating ftnimals is a jwworfQl etimoluit to tlic 
liver, bat Kutlicrford and Vigiuit did not ^ot Uiin resnlt in tlieir 
GxporiiQcnls. 

As tbeae oils remain but n thort time in tho intcotinoa, the grtmtw 
part paseeB oat witli tho motions. Prolit^bly littlo of the wrid 
matter pnsiiiw ijito tho blood, nnco unloM cmtoa oil i» swallnwcd ta 
large qnaotity, tlioso eerious ajroptoma, seen alter its injection iatu 
tbc VL-ini), da nut oconr. 

Like other purgatives, tbcjie oils ma^ influcnoc distant organt, ■• 
the Icidncjx, und act lut dinrotics- 

Croton oil has been used in bydroocplialns, and it in *Aid to ban 
removed tho vxcc«m of fluid from the veotriolee of tho bntin. 

Mr. Sewell. of Ottawa, Canada, rocommondti croton oj] in Kciatwa, 
obxtiiiutc [ilunrodj-nin, nnd crick of the nock, and he stat«a tlial otber 
purgatives cannot be olTeotive!]' substituted for croton oil. He kjn 
graat stress on the evacuation of blackened fnwos. No doubt nemo 
caaesof sciatica depend on a loaded rvctum or dcocending colon, i«lim_ 
any pnrf^ttve will bo useful ; bnt apparently these arc not the 
referred to bjr Mr. Scwoll. This treatment Romotimca relieve*; 
even suddenly cures, unoonstipatod patients, but it prodncce n good 
deal of tvmpomty wcaknoiw. 

Dian-haitt in children sometimea yields to eight or ten drops ot 
castor oil snspciDded in mncilngo ; but, un fortunately, the iudiuatioM 
for tliia troatment being nukuown, it often foils. 

In the early stagos of di(vrrha^a, it ia a common prautioo to ad- 
minittcr a doto of caator oil, to carry away tbe irritant oxoiting the 
discbarges. 

A drop of cantor oil iutrodaced into the eye, nill oft4<n nllny pain 
and inttileiatice of light produoed by a fine irritant, aa aand. 

Cont^ir oil may be takon, almost, if not quite tjislclcasly, in boef- 
teo, lligUly peppered and w<>11 snUod ; or the oil may bo l)ent«a u\t 
with an sqaal quantity of the froth of jiorter, and tossed off bvfnre 
tbe oonstJtnenta have aepatatod. A mixture consisUag of cantor n>li | 
balf an ounce ; fresh mooilage of acacia, threo dmclima ; diatilled 
water, five droobma [ baa very little taste. It may be (litvoared vritb 
oil of peppermint, or oil of lemons. Ii is a good |ilan to pitur Into a 
wetted glass the required dose, and tbeu torn it oS nitl'out lottlog 
the oil impinge upon tlie teeth. 



OLTCBRIHB. 



333 



GLYCERINE. 

Tbr appliottionii of fclyecrine are undleHM- It U ft uaefol spplicatiou 
for chapped lipa and hands; and for rough farfnraoooTiP, and in- 
clflBtic skin, left after eczema, or other nkJn complamta. It reetorea 
auppleneas to tho tissnos, and allajs bamin^, tinglinf^, and emnrting. 
Und!lntod glyoerino raaj oauie inflamioHtion and Rmarting, hence 
it should bo mbcod with nn eqoaJ qnantitj of roso-wator or oan de 
Cologne. Glyoerinii of atorob act* still better in rendLi-inK the akin 
soft and snpplo. In XOToderma, a bath shoaM l>o l«kcn dntly, and 
the ointment rubbed in after wiping tiie body thoroughly drf. 
Glycorino IB a good application for dryness of the nicatas of tho par ; 
and whi,-n tho tympannm ia mptnrcd, it oovon* the o[}eQing in thv 
tjmpaniim with a thin film, supplying for a time tho place of tho 
lost msmbrane. 

Dr. M. Boaenth&l rocommenda glycerine as ft solvent for alkaloids 
employed hypodennically. One drachm of glycerine will diKHOlve 
ten grains of innriatc of morphia, twenty grains of solphate of 
qainia,sjid only one grain of curare. 

The lips, tongue, and gams, when dry and coated with dried 
mncns in acute diseaMM, should Ira ivashed and kept tnoist sovcral 
timesaday with f-lycei-ine, which greatly impn>veM Uie comfort and 
appcamnco of tho patient. If the sweet taste of glycerine is nn- 
pleaesJit, it will answer as well if dilated with an equal quiuitity of 
wat«r or Ismon^jnico. 

In tli9 lart stago of chronic diiteases, a« phthisis, when tho roacons 
membrane of the month becomes dry, red, shiny, and glaxed, a con- 
dition which oaoMB much distrcMK, and in nxually ncoompanidd by 
great thint; ft waahof glycerine and water, to rinse t!ie mouth, will 
relioTe this baiMHing condition. Undiluted, glycerine in apt to 
make the mouth clammy and sticky. Glycerine will sometimi'it euro 
thmsb. 

Glyeerino of carbolic acid is a useful application to fcotid Korea 
and open oaacors of tho snrfnco of the body, or of tho ntcms. It 
removes the offensive odour of the discharge, and improves the con- 
dition of the sore. 

A ])l<idgct of ootton-wool, saturated with glycerine, and applied 
for several hours to tho eongoBt4<d neck of the woml>, will induce a 
cop ions serous diaehftign, and will give as mnch rulicf na the applica- 
tion of leeches. Tho pledget Hhould bo fantonod with a piece of 
twine, BO that the patient berseU can readily withdraw it. 

Glycerine of bonuc is a good application in pityriasis of the aoaJp, 
aphthie, and thrush. 



334 



TIXXIV, 



Oljoerine is mach naecl now in the mAQnfaclare of medicated 
pessaricc. 

Oljrccriae luui Iwftn uRfld io |)laoe of sngar, oh in dmtwtM. It has 
also be«n recommended aa a aubfititato for cod-livor oil, bat experi- 
ence lins »Iiown its inforioritj". 

Otio of tbe beat prevcntiveii of bed-soree is glycerine or ffljeeriiw 
creftm. The part exposed to proesnrs ihonld h» wnakcd inoming a»l 
ovenioiir with t«piil wntc-r, and carefully dabbed cpiite dry willi a aofl 
towel, and tbon kthIIv rubbed OTwwilh a littlo glfoorino or glycerine 
oroam. If (he skin in mt^> or tt-ndor, the Kljccriiie orcein is Imtt. A 
draw-Bbeet mado of linen, nnd KnUicieutlj largo to bo firmljr tacked 
in at both aidoa of the bad, (as aoy folds or cnMOs are v«ry apt to 
produce tenderness, and p^Tntaally sores.) will provent soilintr <^f tb» 
bed>clothMc. This pruvuntiro treatment Kbould bo comoMinirod Wfors 
tbe on-comini; of redneas or tendoroMa. 

It is iin}>ofisible liere to indicate all Uie manifold m«N of glyoeruua 

Glycerine I End usefnl in stomach flattilonce and acidity, a draebm 
to two drachms should be taken sevorat tinim a day in tea, ooffee, or 
water, with food. 

A (oospoonful of glycerine noat, or added to water, is often OKetvl 
in coti|;hs, even the coogh of phthisis. It may be added to a little 
lemon-jaiee, which makos it mi>r<! efGcncions in somo casca. This 
taken at night often lessens morning congfa. It also is nsefal ia 
dry throats. 



I 



ON DIFFERENT KINDS OF TANNIN. 
ON GALLIC ACID. 

Tmsx mbataaoea pndnoe little or no ohange Is tlio unlirokr-n si 
bat act as aBtringwate to sores and mnooni mcnibraues, dif^uking 
secretion hy cuntraclin^ the vessels and condensing tlio tisaaes. 
Tbey pracipitato ■ll)nm<!ii, and thus rant orcT wounds, iu aoino coMt' 
rare protActinp; them from the injurioua action of iho air, wbooea 
taanin-eontaining mb^tanccaaiv applied to exooriationx, itrrtrusely- 
dischargin^ sores, and luxuriant ^■raiiulationiL Tannin in (?«a]w- 
niently employcil in Ihc fnnn of glycerine of tannin. This comliiaa* 
tioD ia useful in ouvna. After ineaslM, scarlet fever, and somu olhor 
iTiiiimnr the inside of tbe nose not nacommoaly becomes uxiviriatad 
and rraldcnod, and diKcharges freuly a thin sanious or thir-kor nnro. 
lent fluid, which, on drying, scabs up the nose, and oft«n tutcilee 
eoMma of the upper tip; now, if the inxide of the nose ia waU 
bmsfaed ont witli glyocrtuo of tannin, the discharge will c«ast, tTM 



TAXXIX. 



335 



N 



> 



tJter a single application ; bnt if the scabs are thick, tbej mast bo 
tbtiroiighly reninretl, to «Dnblu tho Njiplicatton to iKt on tho sore* 
seoretiog mr&cek Gljcerins of tannin ourea syphilitio oKaina at 
cbiMnm; it arrests t]ii? <li«c)iar|ic, rrdiioo* tbc swelling of tbo mucoua 
membrane wbicli prodaces the cbnrauleriBtio snilfliug, and bj cnftbling 
the child to In-etithe tbrongh tho noso, pcrmitA sonnd rcfroiihing sleep 
and proper Kneklin^. 

Occaaionatl}' amonf' adnltfl vo meet with nn impetiginoos eruption 
of tJie inxidv of the noee, moat aercre ni-nr tho orifice vrfacro tbe 
hairs grow, bnt exteodioK bii^lior in n milder form. Scaba block up 
the noses cspcoiallj* at night, and tim alv, and iKimotimrM tlic whole 
of tho nose, is thickened, dusky rod. and very painfnl. The svrellinfr 
nmy extend lo the adjacent stmctnrpx, tind maj nior)H?i> into ropMted 
attacks of cr,vi>i]K!lBa of the face. Dlycerino of tannin, applied once 
or twice dnily to the whole cavity of tho nose, spuodily redncoa and 
even cures this disea»p. Tho upper part of the noso is the mo*t 
easily cured, but tbo discaso ritnntod in the hnirj- part is ranch more 
flbstinntr', nnd is very prone to reoue again and again. Epilation ia 
useful iu obstinate cases. Glyconno of starch or sine ointment, 
applied scroml times a Any, ket^ta tlw tissnes moist and supple, and 
is ft serviceable snpplemeutary application. 

Glyccrino of tannin vrill generally cbouk the uaaal discharge of 
thick, Inmpr. green isli -black, and clinking mucne, and, even nhcn it 
fails;, it ordinarily rcinovud tho oflensire smell. In other forms of 
osnoa, especially when tho disoaiic alTccts tho nppor and bock part of 
the noso witli it« numerous i-erteace, it is pivfeni1>U> to Hash tbo nose 
with a dodonxing and astringent wnsh, in tho way described ; 
nliic^h. bt!!iideH benefiting the muooos tnembrane, washes away the 
inspissated patreffing discbargo on vhich the afench of oza'na 
(irenemlly depends. 

Glycerine of tannin is very valnablc in otorrhcoa. a cummon com- 
plaint of weak onhcalthy children after wttcw illneKses. Tho exter- 
nal mcotas makt be filled with it, and rclftined there by cotton-wool. 
One application nsnatly nnfliceit, but a slight discharge may remain, 
or rotuni in u (ew weeks, when a repetition of the tivatmeot is 
called for. This treatment in inapplicable in tho ocnte stages of 
inflammation of the meatus. This affection is much more difluinit to 
core when Hie ^mposam is destroyed and tho sniall bones are exposed ; 
indeed, in such casea, the tannin only resttsins and deodorixcs tho 
disobarge, which gnumilly returns wltvn tbo application ia stopped. 
Olyccrine of tannin will often cure the obronio vaginitis of cliiWren, 
a complaint gcnomlly miiri' olwtinjtlc tliun eitlier ourna or otorrlioca. 

Olyoerino of tauuin is useful in some stages o[ ecioma. After 
the removal of the scales, if the infiamod, red, swollen, and weeping 



336 



TAXSCIX. 



raw snrface ia painted with tlijs preparation, it notably nlMiM tbt 
diBcbargc^ ndiKss, lti;Bt, aad swelling. A ponllioo most be appliad 
nt nigflit; if the gljoorino of tannin «xo!tG* mucb piun, tho podUioH 
mast be continued night and day. Id a lets sctive stage, wbea th« 
tissues are not §q red, ewollon, and weeping, ccxcma yields still tnoit 
readily to gljcorino of tatiuin, applied twice or thriL-« datlr. A 
poultice is oaoful at night. Tannin glycorine quickly allays Hia tniabl^ 
BOOM itching, tiDf>lin^, and burning, so common in eoxema : braoeit 
prevents tearing with the nailii and ruMiing, which hinder bc*lili(t 
nay, even cause tho eciema lo sjiread. It may not eutiraly rei»n»ii 
tho dtsuam;, but only reduce it to tho dosqaamntire stage, with a 
t«adoticy to crack and onxo, when tar, carbolic acid, or oth«r olst- 
ment« become neceesory to cotnplote the core. Tho Hune treftttncat 
ia useful in intpetigo. A poultice must be applied ekch night lo 
remove tho scabs, and the tivnnin applicatioD sboald be employed 
during the day. While treating these skin diseases, tbo stnto of tW 
digestive organs ntugt not be overlooked. 

Kexemnof the ears, common iu iniddle'SfEedftiid old (mn-de, readily 
yields to glycorine of tannin, unless the ioflanunation roas bigb,wilk 
great swelling, heat, and weeping. This remedy ia also very eCca- 
oiatis in eorema behind the ears of children, one or tvro applicatimit 
speedily drying up and healing the eczema, altbough it may ban 
luted tor wc«ka or months. The gums must bo lanced, if rvd aoil 
swollen, and other irritatianM removed. 

Qlyoorine of tftnnin sometimes benefits intertrigo. 

Equal ports of tiuctare of catechu and liquor plnmbi Is a mahl 
application to prevent bod sores. 

Glyoerine of tannin >s wry usefal in many throat diwaaoa. lok 
medialolj after ncnto inflammation, when the mucoDS menlmas 
grows lees rod, less swollen, becomes moistcr, and is covered wilfc 
mnous or pus, glycerine of tannin painted on the pharynx, buteoa 
recovery, prevents chronic itiHammation with relaxation of ths ma- 
eons membrane which often foltuns the aonte disease^ heals snpi^ 
floial nlceralions ocoarring as the acate inihuniDatien anbudna, and 
OBiei hoarsmeii. 

Olycerine of tannin is useful on the qipaumce of ulceraiioa b 
aphtboiu SOTO throat. Id chronic inflainmation of tho throat wbn 
tlio mucous membrane ia relaxed, swollen. gTa&nlar< looking, anJ 
covered with macns or pus, a few appUL>atioiia of glycerine of (anaia 
brace up the tissues and letisen or remove the hoarsocuMs. Tbii 
kind of throat, nftrn with slight OBlorgemont of the tnosila, k 
common in ohildren, and sumelimes prodaces deafoen. and tlil) 
more often a frequent hiu-king cough, which may keep tlie ehtU 
awake the greater part of tlae night. In children, this ia ao ooei* 



monly the cause of congh, that it is well alwsjs to examine their 
throats. Glycerine of tannia applied dailr speedilj' allays the coa^, 
and cures the deafaees. Throat deabiess is the most commoa form 
of that infirmity in childhood ; and when not dne to ealarj^d ton- 
sils, generally depends npou the kind of morbid throat jast des- 
cribed. 

Many coogbs depend on the state of the throat, a fnct accepted in 
theory, but little regarded in practice. Glycerine of tannin is very 
nsefnl to allay the congh and frequent deglutition excited by an 
elongated nvnla, and the freqnent hacking oongb in phthisis, dne to 
inflammation or ulceration of the throat. A good night's rest may 
be often obtained by painting the throat shortly before bedtime, and 
a sm^t quantity of morphia added to the glycerine of tannin in- 
creases its soothing effect. Mopping the pharynx, epiglottis, and 
adjacent stmctnres with thia ap[dication will mnch reduce the fre- 
quency and violence of the paroxysto* of w hooping- congh. It is of 
little ase if the case is complicated with catarrhal or other inflam- 
matinn of the lungs, tDbercnlosii, or any irritation, as that irum 
teething; but in simple nncom plicated whooping-cough it is tbtt 
useful. The paroxysmal cough oft«n left by whooping-cough, whicL 
readily returns on catching cold, yields to this treatmsm. jr 
whooping-cough and the foregoing throat diseaaea, ghroma: tf 

tannin is better than a solution of nitrate of silver, w i: — — r 

leRfl pain, and is less disagreeable to the taste. (Bat- 3a=Kr f 

Silver.) Glycerine of tannin is more eScaciont 

lozenges. 

Glycerine of tannin is useful in ulceratire sbanmaaas. 

that form affecting only the edges of the gnms : 

better application. (See Salicine.) 

In diphtheria and croup, Tronwen) wneamsis^ •sssx/u^. 

solution containing five per cent, uf -bbbh-.x. ik ■jts. c irin^- 

sevcral times a day, for fifteen rrfTrmiij iiiiiiiim 

Tannin unites with -""i-nJTTTir nrrr n T iiiiis .w^uni: a_ 

ioRolnblo substance, and any tannin icb -a^^na^K. -nrr-riy*. -_,• 

mucous membrane, and kwaw at- msam^m. im. Jnui. ^^■■\- -> 

diminishes the solvent power (^ifaf^Hns ttit- -: ^ '•;»■— w.i ' 

give tannin -containing nAwtamw-m— ■•» -^i^ • '— .t 

It is asserted that tiomn.. wrr 'ztr x r u ^Jrtj;« — » — •:r^- 

alight catarrh of tb* BUmaiOt- 

sioually employed a jmanrv 

pyrosis, but tfity 6i mr 

alkaline, or acii j^tubk.. w ail -mm ?— -a r u 

poisoning by a^uiiiitK m:e-Krrreasm imt -»— pt i ^ 

render them !>«» uiaictL !S^nL me .aii^-.Titr^L 



338 



TlXVDl. 



from tho stomncli. Ti»9 momben of this group wm Htrisgont to 
■nU-alines, k'HSL-iiiu;^ tliuir HoratioDB nnil probaUj' their ooni 
facncc they constifinti?, and Unnio-contftiitiiig BubsteDCOS, as cttt4»)ui, 
kiiic), rvil ^!wxi, rhntiiay, anA hoimatoxj-lum, art' very tuefal in most 
forma of ncnto and clirooio diarrhfea. The mentbora of tliia group 
aru Dmplojcd aa ana] injoctions to check dinrrbcca, to deitrof Uiread* 
worms, and to roettftin prolapsua aoi. 

Few n|>pIicalioim arc m UHRfal in iiritnlilo |n1eai m gallic acid and 
opium ointment. The combtnatioa quickly relierefi pain, and after a 
timu vvun rcdnixn the nirM of tho hatnorrhoitlnl lumoum. Calonel 
ointment, too, is highly spokeu of by my friend Mr. J. Bartlett, 

Owing to tlicir low diffusion power, tho mcmbere of this group 
mnat pass hot slowly from tho intestine* into ths blood. After, it 
not before, absorption into the circulation, Uiey must become n«titi«l- 
iscd with albumt-n, and for this miuion mue anthorities aaajptaii 
that tanuio and its allies So not aot as ustringonts to or^nnH diatast 
from the intealincjt. NwcrthcleMi, (annia an«t gsUic aoid an 
frequently employed wilh considerable benefit to check bleeding fatxn 
the Inngs, uterus, and kidnevH, and with less apparent benefit to 
chock orcr-abnndant sccrution of milk, and profnae swoftting. 

Tannin is sonietimeB admintiitcTtrd to diminish the loaa of alboiBeii 
in chronic Bright'a discaaa, and George Lewald boa oxperimontally 
tested its power in this renpect. In a faw oarefullj-condncted 
experiment*, ho found Hint the albumen was always Imseaed to an 
inconsiderable amount, the daily nvcrnge diminution ajnonQting to 
abont 0'66 grammes. Tnnnin produced a much morodocided inonaia 
in the quantity of urine. 

Ad injection of glycortno of tannin is vciy beneficial in tho after- 
■lages of pmoirhcea, and in gleet, but, as tlio undiluted prupamtios 
eommonly etoitea much pain, it ^honld be mixed with an eciaal 
([uantity of oHve oil or mueiliige. Two drachma of this tuixturo is 
enough for each injection. I'oo much will excite frequcmt a.nd paia* 
fnl micturition, the dixcharge in many instasoos ocaMa only doriltf 
its employment. Urelhml injections shunld be peraevorvd with 
eigbl or ten days aftvr the cessation of diHchuTgc, and as tbc-y ant 
apt to excito seminal omissionB, should not be employed at bedtisM). 

Tannin, either aloiio or blendod vritli otlwr astringents, ia n nsefnl 
injection in leucorrbo-a. In obstinate csags, and n hen tho o« ut*n is 
ulcerated, a suppoaitorj of tannin and cocoa-ant fat applied to Uw 
month of tlt« ntenis is very heoeficial. Oljcerine of tannin ebedui 
tlio gmtt diaoburgu of cancer of tlie uterus, and dtatmys tlio et«neb: 
bnt a mixtaro of glycerine of tonuin and glycerine of cnrboUo acid 
is still more nsefuL 

The oSect of tho members of this group on the natural co&stita 



i 

I 



HAUUCBLIli TIBOrKICJL 



339 



onU of tbo nrinc is nnknoiri). Qnllto Mid " pusoa unabnn^cd into 
tbi; nrino, and hns Imcn delected one hoar ftft«r being taken." TtaH' 
nic acid " piuuteit atf tijr the Brino in thu forms of gutlio and pjro- 
^Uic acids, pmrhaps of a. wwchftrine bodj." (Parkes,) 



HAMAMELI8 VIHOINICA. 

Vabioits p^<^pn^ltlOns of tbo vritch bazel hnvo long been in rogne in 
America among the natives, vrho inlrodaced it to the Ewf^Hsb settler*. 

It is chiefly ompl<^wi in hnmorrbKge, and is moirb Monriconblo in 
pAssive hfemorrbage. Dr. Preston has ein|>1of ed it largely and anc- 
ocMfnlljr in cpiNtAxtii, luid hi* expodenoo ts confimuid by tliat of 
many other writers. It ba« been reoommended highly in the hwrnor- 
rbagio dintbeflifi, Init in tho cuo of a lad with this pticnliarity, I 
employed it in vain on §everat oooaaans in uos».bleediiig. It boa 
been fonnd very scrviccnblo in banaoptjrsis and hronatemwiin. Dr. 
Hall r«oonunenda it in dysentery when the disdiorges contain mnch 
blood. I lukve known it arrest hioniBtaria in four cascw which had 
resisted nianjr otbrr remedies. It la very highly recommended in 
piles, both to obeclc blooding, and to onri; the disoMed veins ; and I 
bftTO fonnd it singnlarly fiocooasful and prompt In arresting this form 
of blooding OT«n when amounting to half a pint a day, repeated 
almost daily for months or yean. It is also very nsofnl in curing 
tbo pilcrs, if it is employed aa an iujeetion for mauy wtwtcs or even 
months. It should be employed either as a lotion, injection, or 
ccrat«, in piles, ne well ua by the mouth. A drachm of the tinctnre 
should bo add«d to three oances of cold vratcr, and injootod oacli 
night nt hndtimi}, or before breakfast. The injection should be re- 
tained. It bus been rocommonded in Tarioocole, nnd one case I havo 
MOD in vrhioh, dnring the employment of this drug, the varicosities 
entiroly, and apparently pcirmanontly, disappeared. 

Dr. Prenton extols it in phlegmitsia dolens. I have fonnd it use- 
ful in checking that slight ooxing of blood after a confinoment 
which may go on sometimes for weeks. 

The do«o is one or two minims of tho tinotnre every two or throe 
Itonn, huge dotwe being liable to ]uodnce seveie tlirobbing pain in 
tbo bead. 



X2 



340 



URSOLIC AOIP. 



TAB, CREASOTE, CARBOLIC ACID. PETROLEUM, OIL OPJ 

TAR, 4c. 

Carbolic acid defitrojre tho lowest forms of nnimnl nnd v^^etabW Uf«^ 
«ji(I pr«i-onlH fcrnientation ami pulnjfmilioii. Wliilat it prurnnU the 
fcnaeutatiou of sng&r, il is said not to prercnt the conversion of 
stnrch into sngnr, nor the decompoitition of innT^lnUn. It i« Iar|^jr 
emplojed to preront the stonclira of drains, w»t«r-elo8ets, disMetiitj; 
roosUi and hnspilnt wnrdx. Unliku chlonno ftnd ]wnnangkml4i of 
pota&h, CJirbolic acid is inmpablc of dpstroyinp offensive Ktute* ; it 
on]y prcvcnle tbuir formuttun. Itit dc-Ktmt'tivo inllacnco oror ifao 
\t>yr forma of animal and vegetAble life has led to its betnj; considertd 
A disinfoctant, but no sntisfnutory proof osifiU of its capnbilitjr U> 
dcfttroj- the oontn^OQB elemeots of disease. If overthelosa it ia exton- 
sivelr, and npimrcntly »'ffi'clTialIy, cmplnytd osn dimiifvctnot. It is 
A good |}lan to hang a sheet, kupt moist with a sotalion of orliolic 
Acid, and lar^t! enou^'h to cover lliu doorway of the aick ohaiaber. 
And to extend a little bi'votid. 

Crcasolo and carbolic; acid act cnorgotieally on tho tkin, prodoeiiq; 
opaque, white patches, and encitinj; active inflammation, foUowod, in 
B few dttys, by dcsqniimmation. They coagulate albummt, and ai« 
atimnlant and astringent; heuoo they may be employed to ohodc 
bleeding. 

Aocording to Dr. J. U. Dill, oarbolie acid, locally applied, is an 
an««t])cti(!, a ntatciniMit confirmed by Dr. Androw H. Smith (.NW 
York Stedkal Juurnal). Dr. Smith painted on his foroann a spot as 
inch in dinmotcr, with an 8h per cent, aolntion of carbolic aoid. For 
A minato it caused slight bnminp;. then the skin bccAmo qnito nnmbh 
nliitiiusi. And sbriTelled; at thin point hit made an im'iniiiD half an 
iacb long without evtni feeling the knife, the woctiid healiup; ba uaaal. 
Three bonra aflrrwards bo thmct, iritbont pain, a noodlo Into tba 
akin, and next he applied n blister to tho carlxili ted akin wtthoat 
causing pain or vusicaliua. He fotind that In iDciaing two wliitloini, 
this application grcnily lessened the pain. 

Profi'NSor KntxnmH Witaon employs carbolic acid as an anmatbetit^^ 
to diminish the imin nritiing from cnoitics, as potassa foaa. II 
over the delicatu jiart or raw nirfaca aeveral timca, theacid coa^latM 
tlie ulbumcn, " bonnnibs tho surface, and permits tho cauxtio aotioa 
with a gTMt reduction of pain." Ur. Wilson employn tbia method 
in lapna, epitholioxna, ancl in diMAse of the glans and prepucs. 

Carbolic acid applied as a stimnlant and anliwirtto to gaagnamu 



1 



■Atheti<vJ 
InudMlfl 
«nhit«V 



OLRDOLia ICID. 



341 



and iU-smelling sores, prevents tlie Ktenolii nnd improree tUo condition 
of tlio wonnd. 

TLe crapy roiinintic oils, lUil Uiuir doriratives, »r« very uH(!(uI in 
nurny citroitic skin aSoctions, oa chronic ocxcma, psoriAsis, orrtlifma. 
The odour of oil of rade, or oloum i-usoi, is lews disagruntkblo than 
that of tar, li(|aor OTboniu datergens, and cnrbolic acid. I>r. McCall 
Audvreon strongly reoommenda thme oils, especially Hqnor cftrboniut 
detergons, oil of cade, and oloom niscI. In most cswx they afford 
immediate relief from the tormeuting itching of uhronio eozeum, 
psoriaiiiii, crythoma, and prurigo, bnt if too long continuod, they ox- 
cite iiifloumation of the hair follicles, forminff papnlee and ptutules, 
with ft black spot in their centre. Hcbra tflrnw tliis croption tar- 
acne. They oftm excite ooDsiderkhla in flam mat ioa in delicate Akina. 
Tht! topical effect of the rapoar oven somotimes prodaooa acnv. The 
parts protected by dothea esoape, showing that this effect is not 
induced through absorption by the Innga. 

These oib are OAefnl in obronia eczema, after the subsidenoc of 
infiainmatton, especially when only a little rodneaa, itching, and some 
deequamnuttion remain. Sometimes [lure tar suoceeda better than ita 
ointment ; bnl if there is inflammation, or if the Burfnoe is mw and 
weeping. It will then excite grcnt [win and InBammatiun. In some 
instanoett the njiplication of tmdiluted petroleum much improves 
loc-al forms of ocicnia, as that kiud oecurriiL^ on the back of the 
hands; but an thin is generally Tory pninfal, other and milder 
romodisH should fir«t be tried. 

Providecl inflatnmation runs not too high, carbolto acid ointment, 
composed of tvn minims of the acid to an oonce of tar. moderates 
the Keeping sloge of eciemn and nllaya the tingling and itching. It 
ia nsoful in the ecxema of the head of ohildren. 

The external application of those remedies in psoriasis u often 
very serviceable, Tar, or ita ointment, seldom fails to benefit chronic 
psoriasJM ; and some nf the most obstinate forms of this diiwnne may 
often be cared by painting the patches of the eruption with pare 
undiluted tar, altovting it to remain lilt it wears gmdnnlly away. If 
the ansightlinosa of the tar ointment ia objectionable, the cniasoto 
ointment, oompesed of two or throo {«rts of craasole to one part of 
white wax, roeomniondod by Hr. Sqnire, may be snbstjtutod. This 
jwwcrfnl ointment muxt bo applied only lo the patch of {nwrinsis, not 
on the adjacent healthy ekin, otherwise it will blister. To avoid 
ataininfi: exposed ]nrt«. Dr. lllcCall AadcTBon sponges the ornption 
three or four timos daily with a wash composed of crystallized car- 
bdlio acid, two dmchms; glycerine, six drachms; rectific^d spirits, 
four oances; distillud water, one ounoe. Dnt ho connidun mrbolio 
acid inferior to tarry preparations. He Gtrongly insists on tbe necea* 



ritj of rabbii^ in the onitniaita tOl tlvf Iht« neil/ diiappaand, 

and, le«t tbc^ become nmcid. of mkhing them oS with nap and 
wat«r before each f reah sp^iotioa. 

Petrolenm Kwp, cade io«i>, uid nHioUc aoap, are nseM in badt 
cbionic eczema and paoriana. As tbeae Maps are made of dllE e i ^ di 

ntnmiifthii, if one kind prove too strong and initadnz. a mild^ bvm 
inajr be substituted. Doctor*, especiallr acooncheors and sarpoB^ 
lue carbolic soap, to free their hands from infections or noxioiia nnA- 
ten which mi^t endanger their pktiente' afetr. 

Carbolic acid has the great advantage of being free from ocdonr. 
It is nsefnJ in eczema, psoriasia, and prarigo, bat it is gatenDj cask 
sidered inferior to tar. 

Dr. Alder Smith finds glycerine of carbolic acid Terr nscfnl in the 
earlj stages of ringworm. 

Dr. Eode recommends the nse of carbolic acid for carbuncles and 
carhnncniar boila He eroplt^s a Rotation one part of carbolic acid 
in fonr of gly ccrinc or oil, and soaks in this small pieces of lint, and 
thmsts them throngh the opening of the broken skin to the bottom 
of the botes and sinuses in the carbnncle, and keeps the snrface of the 
carbuncle covered with lint soaked in the solntioo. This application 
lie maintains prevents the extension of the carbimcte. This tieat- 
ment is only nsefol in tliat late stage of the carbuncle whcm the akin 
is brokoQ and the csrbnocle disctiarging. 

Professor Hutcr employs carbolic acidhypodennicaltyinerymp^as. 
He uses the following formala : carbolic acid and alcohol, of each 
3 ss; distilled water, ^ij. Of this six to eight sjringefots Bhonld be 
injected at different points where the inflammation is most intensa, 
and should be repeated next day, or in a few days, if the disease 
spreads. 

Glycerine of carbolic acid appears to mo to be higlily nsefnl aa a 
topicnl application in the throat in diptitheria. It should be applied 
only to the diseased portions of the macons membrane, and should be 
applied twice a day. 

A weak solution of carbolic acid is a very useful injection or wash 
for the cavities of targe abscesses, or in empyema, after the evacua- 
tion of pus. A like injection will correct the fcetor ariaing from 
cancer of tbo womb, or other uterine diseasee. Carbolic acid, it ia 
said, will remove the stench and lessen the discharge iu ozena. 

A lotion consisting of one part of carbolic acid to one hundred 
parts of water is strongly recommended in pruritus ani. Dr. J. 
Thompson employs marine tint soaked in carbolic lotion. He poshes 
every night a small plug into the anus, a part being left as a pad out- 
Bide. Carbolic acid is nsefnl in pruritus pndendi. It may canse 
oontiderable irritation both in pruritas ani and pudcndi, the skin 



UEBOLIC ACID. 



343 



\ 



sometimes botng ko ttolicatu tlmt orm a wok npplication cattsea con. 
iiidomblo bumin); and smarting. 

'Die iubalalion of cmunto or carbolic ncid, ten to twmtj dropfl is 
boiling water, is OAofuI in broncbitis, l«««mng in nnmfi cMM orcr- 
abuudant expoclomtiun. It vrill gwcrnlly rcmovo the brcatli fcetor 
occnsionally met witb in bwncbitis, and sometiini^ even tbo fctttor 
<luG to gniigrondns lung. Tha iiihid»tinn of even ten drops produoea 
in somv petSoDs tpddinoBB and sensation of intoxication. Inlinlntion 
of Gorbolio odd witli hIoud, or in Hpnij, is useful in whooping-- 
cough, 

CrcMoto, mixed nthor with ttuinin or opium, introduced into the 
hollow of a docajed and painful tooth, often givai rolief. 

A creiwote or carboUo gftrglo or tviub proves very offlcat^oas in 
slougliB of the moutli or throat, romoring the ulTcnjuve odour, and 
producing a healthier action in tbo tmrn. 

Small doees of oreaaote excite no particular Nj-mptoms in Iho 
stomach, bat a large quantitjr prodncus a sonsatiou of bnruing at tbe 
epigsMriam, with nausou and vomiting'. 

During iti transit through the intestines, creosote appears not to 
uTidcrgo any cliaiigo in ramjuHitiou. as ita ohnrnoteristic odonr may 
bo detected in erory pnrt of, the canal. It checks the vomiting of 
vmrions dIaeascA, as tliat of pregnancy, sea^iokncM, cancer, nicer nf 
the stomach, Bright's diwaw. It often promptly reliorm stomach 
pains oocnrring after food. 

Tbo invcstigntiouM of Dr. Sansom, who first employed 6ulpbo- 
carbolates in medicine, prove that these salts arrest fermcntuliun in 
diflcront degrees, eulphO'Carbolato of sothi boing most efiloient, then 
follows a salt of magnminm, then of potassium, then of ammoniani. 
Adminislerad to animals, thoy prevent pnlrofoclion and docom position 
of urine, although Sanaom could not detect any of the salt in tbin 
cxcration. Ho ^ve snlpho>carbolat«, and than coll(.-ctoil and pre- 
served the urine, whidi after six months had not undcrgooo dectim- 
position. 

Siilpho«nrbolato of soda and carbolic acid arc rery niictal in flatn- 
lenoe, eapecially when there is gnat distension, nnaccompanied by 
pain, heartburn, or other dysjieptio symptomii. Solpho'carbolato of 
soda will generally relievo extreme flatulence, producing copious 
eructations and oonsidonkblo diclcnsion, aymptonix not nnoonunon in 
middle-aged women and phthisical patients. Whenflatulcncooccnrs 
imme<Uately after a meal, ten or fifteen grains of snIphu-carbuUte 
of soda slioold bo taken just before food ; wlien it occnn some time 
after meaUi the medicine in Uie tame doiw ihonld be taken half an 
hoor aftiir food. 

We often meet with patients, gonerally woman, who snficr from 



SM 



ciwoiic len. 



i mitt ta orAamnlj oUed " fpuaa." Tbe {Mtaaal m— |J«*T*f of 

■mImwM* fiatnlonc* and distnuioti, often Itnitcd to one f^tt, 

sometiiBei nuMt marked m aot part, of tlw ahJomta, gcwmllr on 

;• tfa* kft aids mdar tha riba, acoompanied bj aerers paio. vhic^ like 

) Iha Batvlaaoe itaelC, it often moat markad andor tlia kA side of tba 

'dwat. Tlw pain, tcmponnlT^ ralivred bj tiie erBctatioD of a little 

['wind, aooo retnraa and may cndnn manj lionnt, and maj (reqncittljrj 

leenr. In fotaa caaee ths complaint is eridentlr a aeoralgta of 

of the abdomiiisl norraa; the pain botng ckioflj excited fa; 

lenc«. SulpbtMMrfaolatoa often afford confiidiorable nlief, hy 

Tenting the fonaation of wind, bot in aome caaca I hare 

phoaphonu Car more prompt and its remedial effeei more 

, aent. 

Creatote Iiaa been given in cholera and tj^hna ferer, bat appar- 
ently irithont mnch benefit. 

Crcaaota pavea into the blood, and iu odonr b detectable in 
of tlie OTfiaaa, slwwing that it probably rcinains in chief part, if no^ 
entirely, nnnltorcd in the binod. 

Tar, cteaaotei and carbolic add an> nscd in bronchitM and is 
pbtbina (o oheok both tlw quantity of tlte expectoration and iU 
oSeasiTeneM. Th^ are CNpceially a«cftil in cbronic bronchitiK. 
Tnr-imtcr if an old-bshioiMd and approved remedy in bronchial 
complaints. The frcqaent and popular nso of tar-irntcT, both by 
the profesnon and by the laity in Knnce and Bcl^^ictm, led me, 
oonjnDCtiion vrith my &iend Ur. Hnrrell, to try its eficcts. I^tioot 
ao BTuovptible to cold that they irere obliged to remain in^doora the 
whole winter, informed na that this remedy cort&iled considerably i 
the duration and Icmencd the aoverity of their catarrhal att 
and iliat, by an occasional recoorae to th« tor, they became 
prouo to catch cold, aod conld more freely expoae themadToa lo thgil 
wee the r. 

Wc employed tor in two-grain dosee, in a pill, every three or four 
boBTs. From October to Jannarr, inclasirc, wo caivfiilly watcbcfl 
its cITi>cta on tirenty-five iwtients, wbuee ague variud from thirtT-fuiir 
to seventy, the average being forty-four. All these patients had 
suffered for aevend yean from winter-congh, laating the vho]« 
winter. They worn ont-pationta, and visited the hospital weolcly, or 
oftcDcr. Most of them were much exposed to the weather, whihit 
aome being so ill, were obliged to stop work, and thorcforo waro less 
exposed. 

Xhose patients soffored from the symptoms common in winter 
cwngh — paroxysmal and viulent cough, iLe paroxTSntR lasting ftoiai 
two to ten minalce, lecnrnng Ufa to twclvD Limes a rfnr, and, in the* 
night, spoiling sleeps The expectoration, frothy and aligbtly pom. 



CARBOLIC ACID. 



»46 



l«at, was general!}' rather abnftd&nt. amounting m some oases to half 
a pint or more in Uio ^aj. Thu breathing '*'■>* vs>7 short on oxor- 
tioti, but moet of them could lie dovm nt niglit without propping. 
Tim phjuicnl nigna Hhowed a variable amount of crophyscraa with 
sonorous and sibilant rhonchns, nnd occnsionally a little bubbUnj; 
rhoncuR at the hate. 

These patients nsanJl^ Iwgftn to improvo from the fourth to the 
Herenth daj; the improvement rapidly inurcued, and, in about 
throe weeks, they wore well enough to be dischitTgod. The improve- 
ment wnj( 10 decided that the patients returtiod t» tbcir work ; even 
those who, in previous jonrs, bad becD confined to the honao the 
whole winter, Tlie congh nod oxpeotoration improved before the 
breathing. In sevei&l cases the expectoration iocreMcd during tho 
thrtia or four first days; but itn expulsion became eositir, and with 
the tuipruveineut in the cough and cxpectomtion, nppotito and 
strength rotnmod. 

On dineontinuiag the tar, a relapse often occorred in a weelc or 
two, and the patient rotnniod with a roqncst for more of tlie same 
medicine, and then, a seound time, the sjrmptoins quicklj subsided. 
We found it nsvloss in bronchial asthma, and its effeetn were moro 
evident in cases where expoctofatten and cough were more marked 
than d7Hpoa>a. 

We hare no doubt that tar is a good, useful, though, perhaps not 
a striking, remedy in lhc*o tninblonomu affections ; and ocrtainljr it 
is more efficacious than tho dmgs generally employed. 

It auiy be rvmarked that tor is useful in the same case« for which 
the ipmy of ipeemonanbn wino is serviceable. Tho spray, wg find, 
acts much moro quickly, and unlike tiu-, it lessens dyspnna even 
bvforo it improves cough, or diraiaiaheB expectoistioo. (See Ipe> 
caonanbn.) 

In winter-cou^h and chronic bronchitis, obbmoI* in two miniBi 
doses, either in pill or mixture, or floating on an OUiM Af mtvr, is 
said to be effioaoions. 

Dr. Andenon gives tar in chronio cosoma. He bcgimi -with three 
or four minims in treacle, pill, or capsules, gradually increasing tho 
doao tu ten or fifteen minims tiireo times a day. In gangrene of tho 
lungs, creasotfl is employed to obviate the foitor of the expectoration, 
and as an inbalalion it certainly saccucils, thongh when swallovrod it 
is of doubtful efficacy. (See Salicino.) 

Oppnaaion of the head, e|iigaatria |Hun, vomiting of dark coloured 
fluid, and black motions sometimes occur after the application of tar, 
though mrcly except when applied over a large area. 

Carbolic aoid ia readily absorbed by the skin. Internally and oven 
cxteniatly it may, evea in small qnantities, produce somvtimos serious 



34C 



CIKBOLIO icm. 



epnptoiDS, eomo pnti«Dts lietnp iflact«d nmoli more Ttmiiif tli^B 
othen ; it may «iinte serore vomiting, giddinsOT, dslinam, oontnc- 
tod pnpilm irrcgnlftr brcnlhing, Ittnaaig^lobinnria, even to comn or 
collapee, witli vieak palao nud rold sweftt. lowm«d tsmpomlnre. evnt 
to itGvend dvgne*. ThcAc toxic njmptom* nrJAiiig fmm cnrbnlio acid 
are, il is ^d> best romoved by tlk« free nso of tlilocntfi ; ao donbe- 
Ima tho KymptoRU anaing from tor would be benefited b]r tbo ■Hair 
mc&Di. Injoctod undor tlio tikin of » fmg, cnrbalio sold cnnsca iroak- 
ness, paaiiuK into comptota pandyiiis, iionvulsiotiB and death. Sli^'ht 
irritation of the skin induces Tioleiit convnUionK. Tlwuo cotiTulsions 
are central. Salkowski, Jolyd, and Stone, bclievo thoy tlcptnid ocr 
the action of tho poUon on ttio apioal cord. Labbo »tid Hajnoi 
conclude from tlicir oiperimvntA that tbo convnlsiona are dao to tho 
oSoct of tho poinon on tlio central bncot ganglia. 

The oonvultiiona aru tetanic m f^^g)^ but clironio in witrm -blooded 
animals. Professor Csomy describes a chronic oarbolic poisoain^ 
wfatL-h attaclcKdurgeonH muoh cxpoMid to the HpiajT. Thoro i^ aliglit 
headache, broncliinl irritation, languor, climiniHhed appetitw. The 
logs foul hoaiHi-, tht^rc in naunui, cdfiucially in the morninif. Tho akin 
itches, the patient complains of insomnia, and U anjcmio. Thrae 
Bjimptonu diKippcur with a fow djiys' absence from tho oxoitiag 
oaaao. 

Carbolic acid In recommended in feven, to rodnco tampenttnre. bat 
it is inferior to many other antipyretics. Liko other antl-iiyrvtic* 
it has a greater effect on tbo fobrile tluui on tho non-febrilo ton- 
pomture. 

Tar and orcB«ot« are reputed to be diaretlos ; and, as rano q( tho 
ingrcdioots of tar pam off with the nrine, cbaaging ita colour mad 
odour, thoy may posaibly act on the urinary tracA. Thna tar, orMaotCs 
and carbolic acid, admimntert'd either internally, or applind ext«r* 
nally, canso sometimes at fina dark -colon red, and soniutinioa black, 
ari&e whioh gmdnally bocomes lighter in lint. It is said thai Ui» 
urine is oolonnid dark moro fro(]aently from tbe external thnn fnim 
tJio internal xute o( carbolio acid; and Forriorsoggorta tbnt this is 
owing to its becoming oxidixnl before ila absorption. SorootiinM 
the urine is natural in ooloar when first poMiod, but bocomea dark on 
ataading. Ob tbo addition of sulphuric acid, tho odonr of tar ia 
nndily porooired, and cblnriilo of iron dovelops a boaotifiU Ubo 
oolonr. Tho looal application of dI fogi. ol nutoi, ol oadiai, ocoasioa. 
ally affeols the nrine in tlie same manner. The nrinuiy ohnnges are 
<«peoiaIly marked witJiin tlio lirat few days, but after a tinw theM 
duugeH become scarcely perceptible. The urino reinaiaii olaar 
throughout, rarely contains albumen, and doeii mit ciUibit au axoans 
of inm, abowing that the diaoolomtiou is not due to disiutaKtmlad 



I 



« 



CAEBOHO *Cro. 



347 



blooil corpntolcs, Tlio urine, in boalth, DontaiDB a tioce of cnrbnlio 
acid. Carbotio ncid andcreaMiUtsometinieBncitostraii^ij. CnrbDlio 
ncid and fintphfl-carbolntoB lulminiHttirml b^r Uie stomach prevent, 
as wo liave sliovrn, deconi petition of tho urinv; poMiblj Haene drufts 
may pTp